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09/13/2001 11:53 FAX 209 9480 002/002 <br /> SEP 13 '04 11:19AM CO "LJD ENGINEERING Imp, P.1i1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTJR DEP_A.RTMENT <br /> 304 E Weber Ave 3r1 Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web; www.co.san-Joaquin-ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY. 1 <br /> ADDRESS: <br /> PHONE: 2D__ 9_�?—��_ FAGSIMtLE: Og— q�7— A7/y <br /> TENTATIVE'APPOINTMENT DATE. Time: <br /> (Please allow 10 businesz days from date of application submittal) <br /> © CHECK BOX To EXPEDITE REQUEST.$93.00 F —REQ T PROCESS I BUSINESS DAYS <br /> SIGNATURE of APPLICANT DATE Z,La <br /> Department Use ONY <br /> FISC ADDRESS UNIT <br /> 1. sit—, GI <br /> cn ❑ Unit 1 <br /> no Q a iA r ❑ Unit 2 <br /> �. avaei s- !l <br /> Cry <br /> r. 9lrooC� <br /> C. etrene Ct ❑ Unit 3 <br /> r. g•�� nr. ❑ Unit 4 <br /> 7 <br /> ❑ Unit 5 <br /> 10. C4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> p UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABAT@MENT ❑.SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) U FOOD FACILITY ❑ SOLID WASTE vEHccLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL o DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKrN RANCH M.PKIdTREATMENT PLANT <br /> d TIERED PERMUF E4 FACILITY Q MOTELIHOTEL t] PUMPER TRUCKIYARDICHEM TOILETS <br /> G TATTO01BODY PIERCING Cl POOL/SPA 4 LAND USE APPLICATION SfrES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available, <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD Staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. `TENTATIVE appointment (sates must be confirmed with EHD staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED <br /> Post-it`Fax Note 7671 care Q 130 4 Pa91 <br /> REVIEWED YES NO To Dd V5 VAGyr--C�1 From A1-, <br /> Co./Dept <br /> END 4e.02-005 <br /> l'C lel rt °� Co. C <br /> Oimm Phone Ji Phanq C p�-7_ n 7 <br /> a"` 0i-5 7 -8 77 <br /> 09/13/2004 MON 11:16 [TX/Ra[ N0 7273] 0001 <br />