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06/16/04 WED 08:49 FAX 916 °meq 7013 KLEINFELDER .........:rd0,� DATE RECEIVED SAN JOAQUIN COUNTY ",y FD-)EE �,Vj, (�U ENVIRONMENTAL HEALTH DEPARTMENT (�\ I� 304 E Weber Ave 3'd Floor Stockton,CA 95205 JUN 12004(2)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.causlehd 41 ENVIRONMENT HLALTH PUBLIC RECORDS RELEASE APPLICATION P MIT/SERVICS K1P�n ader, Inc . APPLICANT: BUSINESSIAGENC`Y_: ADDRESS: 3077 E'de PHONE: OIC )No 0— I�D , _FACSIMILE: TENTATIVE*APPOINTMENT DATE:IT1 u01,1 r ear eS+ nYIV'U1fP�me: (Please allow 10 business days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST-$93.00 FE REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE �Q//&,Lo4 Department Use Only FILE ADDRESS uki, ,. saee, 4H77 1&� - ❑ Unit 1 2. save, y y e- s. saes q2 ❑ Unit 2 ` 4. sa«, I I� s. , Unit 3 a save, �. saed vi Unit 4 a scree, `7 W n s saed 4B?-,') W ❑ Unit 5 ,o. sweet LAO 8`7 V e- a ENVIRONMENTAL HEALTH DEPARTMENT FILES M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Iff HOUSING ABATEMENT 13 SOLID WASTE FACILITY LM OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE 19 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY 63 HATJIRDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL E3 PUMPER TRUCKIYARD/CHEM TOILETS E3TATTOOBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10)days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. Anew application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit priorto review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX- INITIAL$S - DATE YES NO REVIEW DATE ` EHD 49-02-006 - &WO03