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Aua-09-04 21:43 From-TTI TETR/7--CH E61 INC +9166520307 t <br /> T-017 P.02/02 F-22T i <br /> EHD LOG NUMBER I <br /> DATE RECEIVED SAN JOAQUIN COUNTY - l <br /> [0 <br /> ENVIRONMENTAL HeAiTHDEPART T <br /> 304 E Weber Ave 3r4 Floor Stockton,CA 9520 l { <br /> AUG 1 0 2004 (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaqu' .Cd.u�ehd <br /> ENVIRONMENT PCTBLIC RECORDS RELEASE APPI.ICA ION <br /> PER RVICEr,- 4, j <br /> APPLICANT= NIrgCr� �. t�d�fr7Y [4 6u51HESSIAGENCY: �M <br /> ADDRESS: <br /> (067y C4 <br /> PHONE: ?7/�� , b FACSIMILE: ifSZ-030 I <br /> TENTATIVE•APPOINTMENT DATE:. t1C1• µy� r I <br /> (Please auo to msinee6 days fmm om of appl{emlwl <br /> ji <br /> Q CHECK BOX TO EXPEDITE REQUEST-*93.00 FEE-REQUEST PR E N3BUSINESS D YS <br /> SIGNATURE OF APPLICANTMDATEDeparime w Only 1fuM1T <br /> I2 S .0 G• /O T.ft3 Baa 5 w. Una 2Zar co . c�H 5. s� , 12 . G R[ 44e unit 3 ) <br /> n vow, G <br /> e a& c UPit4 �; <br /> s scud, c.l nn 5 I <br /> ,o sumo <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE i` <br /> UNDERGROUND TANK(UST)CLEANUP SfTE(LOP) M HOUSING'.ABATEMENT O SO D WASTE FACILITY !� <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY t7 SO JP WASTE VEHICLE <br /> UNDEROROUNO TANK(MONITORINGIREMOVAL) M DOG KENNEL 1 D Y li <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH M PK 1 TREATMENT PLANT !j <br /> P TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PU PERTRUCKIVARDICHEMTOILETS., <br /> ❑ TATT001130DY PIERCING 0 P000SPA O D USE APPLICATION SrTES 11, <br /> Cl MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)- <br /> f: List up to ten addresses in the space above. Select the type(s)of files I om the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax t 209 464-0138 or mail to the <br /> address indicated above. II <br /> 2. EHO will notify the applicant if any EHD files exist- An appointment for aview will be confirmed ;'i <br /> approximately five business days but no later than ten(10)days after r eipt of application. The fates <br /> will be held for a maximum of five business days for review. Appointrint nts should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immedia ely available for review. A new <br /> .1 <br /> application may be submitted when the file is available. !' <br /> 4. Any file not returned in the same condition as released will be reorgan' by ENP staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require 1$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. ik <br /> 6. Applications received after 3:00 pm will be processed the next businest day. ; <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE — <br /> EnG�6e2iW6 <br /> If <br /> N6ROY] �'I <br /> k <br />