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09/13/2004 11:53 FAX 209 948CC,, [>fj. 002/002 <br /> SEP 13 '04 11:19;M COSTdUD ENGINEERING P.1/1 <br /> DATE RECEIVED SAN �l COUNTY TOAtZ(]IL��I. EHD LOG NUMBER <br /> ENVIRONMENTAL HEAL-Tit DEPARTMENT <br /> _ 304 E Weber Ave 3ro Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web; vrvw.co.san-joaquin.ca,us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r_� I. 4dZ�0( - BUSINESSIAGENCY. <br /> ADDRESS: <br /> nnE sna NA eJ I)r l VP t -5tl Q,z CA9 za0� <br /> PNONE: .�CD7 _ 9,37- A7F <br /> 27 FACSIMILE: «209— q37- 6277 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please elfow To business days from date or application tebmittal) <br /> E3 CHECK BOX TO EXPEDITE REQUEST-393.00 F —REQ T PROCESS 1 BUSINESS DAVE <br /> SIGNATURE OF APPLICANT DATE I O <br /> DeDanment Use Only <br /> FILO ADDRESS UNIT <br /> I. 34mo -city <br /> a avaa� I ❑ Unit 1 <br /> s. slro cl ❑ Unit2 <br /> a. arae: O <br /> 5. <br /> s"e c <br /> in.., ❑ Unit 3 <br /> nj <br /> }. a .01 CI <br /> ❑ Unit 4 <br /> e, eraal G. <br /> a. seam CB ❑ Unit 5 <br /> 1a. apse, My L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0/U'N'DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINGABATLMENT M.SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD PACILITY ❑ SOLID WASTE VEHICLE <br /> 17 UNDERGROUND TANK(MONITORINGIREM OVAL) ❑ DOG KENNEL D DAIRY <br /> ❑ HA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑.PKG TREATMENT PLANT <br /> ❑ TIERED PEPAr TEb FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> O TATTOOIBODY PIERCING ❑ POOLISPA M LAND USE APPLICATION SITES <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 t0(209)464.0138 or mail to the <br /> address Indicated above. <br /> 2. END will notify the applicant if any EHD files 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 /> S. "TENTATIVE appointment dates must be confirmed with END staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT[)ATE <br /> DATE CONFIRMED Post-it'Fax Note 7677 Dare 4 1304 pag'as� 1 <br /> REVIEWED YES NO TO 1�. OU NGppGC 1 From Ak- og�o ee <br /> sem ae.oaace 00./DePL(.<iein{e~ CCr Ce- <br /> &42M phones Phones 937-8787 <br /> a " '9 -06 I F"" a37-877 <br /> 09/13/2004 MON 11:16 [TX/R7[ NO 7273] jaO01 <br />