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09/13/2004 11:53 FAX 209 948 2002/002 <br /> SEP 13 194 11:19RM CC�MUD ENGINEERING 'l P.1/1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JoAQoIN COUNTY <br /> E' NVIRONIMENTALHEALT$DEPARTMENT <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 /> r� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AL A.rt9aZ O(LBUSINESSSIAG,ENNCY .� <br /> ADDRESS; /in <br /> /.JA%A/ I�rl VP_ 1 SIG <br /> •a <br /> .0 <br /> PHONE: D4— r3?— Azg7 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Ploase allow is business days frota date of application rpbmitta0 <br /> En CHECK BOX TO EXPEDITE REQUEST-Fs3.011F _R Ql $TPROCESS I BUSINESS nAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DeDanment Use Only <br /> FILO ADDRESS UNIT <br /> 1. Su., Oily ❑ unit 1 <br /> s. swot o <br /> c ❑ Unit 2 <br /> 4. 9°°eI 0 <br /> c11 C] Unit 3 <br /> ci <br /> 915 1 c"' ❑ . Un1t4 <br /> 9. 8✓°°I t.. <br /> cn <br /> Unit 5 <br /> ch, <br /> ,f/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> p UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINGABA%MENT M.SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLO WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑.PKG TREATMENT PLANT <br /> O TIERED PERMFIFTED FACILITY ❑ momi oml. ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> M TATTOO/BODY PIERCING ❑ POOL/SPA rZ 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 to(209)464.0138 or mail to the <br /> address Indicated above. <br /> 2. EHD 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 far 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 some applicant may require a$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be conNrhted 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 Past-it'Fax Note 7671 Dare R I i�04 pages 1 <br /> REVIEWED] YES NO Tc 17Cu ��'� From A�• G �� oZ�ob <br /> e 4M2ac" CoJbepL K let n P � O <br /> e- Ce. <br /> s,tC_ .�j <br /> ew . <br /> vmw Pho"e6 -!e- Ph°"°« 937-8787 <br /> a37-877 <br /> 09/13/2004 MON 11:16 [T%/R1( NO 72731 la001 <br />