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�.r»ILnn4 ey:1 9252836121 AEI CONSULTANTS (SF) PAGE 0 <br /> D h'El <br /> VED - <br /> Lnj � AN OAQUIN COUNTY EHD LOG <br /> SJ � <br /> EN VMON?dENTAL)UALTH I]EPARTmENT i <br /> APR 0 7'X004 304 E Weber Ave 3'd Ploor Stockton, CA 95205 <br /> EfVV Rt i�' `� ,.;!QW)468-3420 Fax: (209)464-0138 Wena: www.co.san-1oaquin.ca us/ehd <br /> _ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: rlI`� BUSINESSIAGENCY: r <br /> ADDRESS: <br /> PHONE,�[X FACSIMILE: -gs-6 b 1:7-1 . <br /> TENTATIVE*APPOINTMENT DATE:-AA5 0 Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$$3.00 FEE—REQUEST PROCESSED IN 3 BUSINESS I)AY5 <br /> SIGNATURE OF APPLICANT DATE "I <br /> department Use Only <br /> �. FILE ADDRESS UNIT <br /> 17 t. s 1(UOS X35 O gu 2-vsk4y,0 0Unit i <br /> 2- C7 0 <br /> 3. <br /> 'IcoG1 Do <br /> rd c1tv <br /> s. r �11� Cuter UCIit 2 <br /> s. 25 5. } . $� <br /> e. I ' 1 st, o EI po' o !� Unit 3 <br /> t� <br /> u II tyn <br /> My <br /> ` d[' Unit 5 <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> uNDERGROUNb TANK(us r)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SrrE(NON-LOP) n FOOD FACILITY SOLID WASTE VEHICLE <br /> NK UNDERGROUND TANK(MONITORINWREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH X PKG TREATMENT PLANT <br /> TIERED PERMITTED 1-ACILI Y d MOTELMOTEL CI PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOISODY'PiERCING ❑ POQI.ISPA r LAND USE APPLICATION SITES <br /> 0 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 aboye.by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-01380T ma'l 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 for a maxImurn of five business bays for review, Appointments Should be scheduled a <br /> accordingly. <br /> 3. Afile That is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application maybe 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 thel;applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B• Appllcatlons received after 3:00 pm will be processed the next business day. <br /> ,.... 1r; <br /> 'C0NF1R.ME1F!!APPOINTMENT f3ATE - tJNE <br /> DATE CNFIRMEQ Y...' <br /> "PHONE: FAX.- . IMITtALS.; <br /> REVIEWED• :. %.YES NO REVIEW DATE <br /> ' el�a�s•us-0os <br /> ararz000 - . <br />