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U4105.12004 09:27 9252836121' AEI CONSULTANTS (SF) PAGE 0 <br /> DATF R EGL�V�o <br /> LRSAN-JoAQXI'LN CQuNTY EHO LOG <br /> { <br /> I <br /> ENVIRONMENTAL MA]LTH DEPARTMENT s <br /> APR 0 7 2004 304 E Weber Ave 3'Floor Stockton,.CA 95205 <br /> Ef�Vli�v'vi,` ! ( 99).4.68-3420 Fax: (209)464-0138 W6:wyvw.co.san joaquzn ca.us/4d <br /> I'EE;M!T1S <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: , , <br /> gU51N1_SSrACIwNGY: � <br /> ADDRESS: rruu22 <br /> PHONE: FACSIMILE- atT7�J 1 <br /> TENTATIVE*APPOINTMENT DATE:—4115/0q Time: — <br /> (Please allow 10 business.days from date of appiicatian submitMal) <br /> CHECK SOX To EXPEDrrE REQUEST-$03.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Depalt tent Use Only <br /> .NILE ADDRESS UNIT <br /> y :. 1(005 X35 ,�� o a �oc.k•�(1 i <br /> a O G „ Unit i <br /> 3. `I S. G1 Dora Ci I' �Ja�lY!L� <br /> Ill Ce,(vt%.r 1� Unit 2 . <br /> Unit 3 <br /> s. � �� S,El �af•A.CIv e; 1i <br /> - u <br /> d <br /> li n <br /> Ax <br /> sveee t <br /> IQ. Sued Unit b <br /> aty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> h=. 4 <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP srrE(NON-LOP] ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORiNGdREMOVAL) ❑ "KENNEL ❑ DAIRY <br /> HAZARDOUs WASTE GENERATOR G CHICKEN RANCH `,� PKG TREATMENT PLANT <br /> TIERED PERMITTED IACILITY E3 MOTEUNOTEL LI PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOLISPA Mk LAND USE APPLICAT_ION 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 249 464-0138 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 for a maximum of five business days for reVISW, 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 fire not returned in the same condition as released►erill 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 /> 6- 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> RM�I~I NT DATE' ;..� �;•r;_; <br /> CQNFI APPOINTME - TIME <br /> � ..PHUI�I :, a: •, ' r <br /> DAT <br /> NFIRMQ FAX <br /> . '� <br /> r�rr <br /> -�.r `rA�s... <br /> REVIEWED YES NO REVIEW DATE - k <br /> EKD 4:E M <br /> alerzaoa - . <br />