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Auc-09-04 21 : 43 From'TTI TETF 'CH EM INC +9168520307 T-017 P . 01 /02 F-227 <br /> q DATE RECEIVED SAN .IOAQUINCOUNTY VhV LOG NUMBER <br /> ((�o (� /r , <br /> U U Lam ? „ I ` , :I � rENVIRONMENTAL. WEALTH DEPARTME T <br /> 304 F Weher Ave 3` 1 Floor Stockton, CA 9520 ��� <br /> AUG 10 2004 (209) 46$-3420 Fax: (209) 464-0135 Web: wwart j <br /> w .co.soaqu' ca-MVehd <br /> ENVIr a W1ENT HEALTH PUBLIC RECORDS RELEASE APPLICA ION <br /> I, PE <br /> j APPIACANT: �>=� a11 . • L—akW 'Z;D BUSIN€SSIAG€NCY. k -C PJB l GH eMi <br /> ADDRESS: 1 1FC . 7* t NcAAv C.P (Z V C4 L, 775 <br /> PHONE: Q 1 I„ - E 53 - 4 54b FACSIMIL€: <br /> TENTATIVE' APPOINTMENT DATE: 71m®: QMn� <br /> j (Please allow 1e Ou5i0ab5 days fram date Of applicatzon aupml 51) <br /> i <br /> © CHECK BOX TO € FPITE REQUEST - $93-00 FEE — REQUEST PROCES PIN 3 B INESS O YS <br /> SIGNATURE OF APPLICANT DATE d 2y) <br /> peparu I Use only <br /> 1 E ADDRESS UNIT <br /> 22Z E , yYl3 Js.V E. c 5Tb G C [] Uf1R 1 <br /> 2. 54"t 6 S_ fit rm . ciriA — I <br /> 9 5vaa 3 E . - q Unit 2 <br /> sem. T <br /> c 35 U �L <br /> s sem, S'. 4--1 Cf) 1' h c f - <br /> 5„� a A4FFA7 L V. C. 35 /Y 441rnt 5 <br /> 5veai a o3 F rpLa s� 7Q c 35 - <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) F) HOUSING AF4AT€MENT A SO 10 WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOP FACILITY M So ID WASTE VEHICL€ <br /> UNDERGROUND TANK (MONrroPING/REMOVAL) ❑ DOG KENNEL to DA Y <br /> HAZARDOUS WASTE GENERATOR M CHICKEN RANCH CI PK TREATMENT PLANT <br /> Q TIEREP PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PU PERTRUCKA(ARPICHEM TOILETS <br /> t3 TATTOglaOPY PIERCING M POOUSPA ❑ P Us€ APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br /> I . List up to ten addresses in the space above. Select the type(s) of files f am the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax t 209 4640138 or mail to the <br /> address indicated above. <br /> 2. FHP will notify the applicant if any EHD files exist. An uppointmant for eview will be confirmed <br /> approximately five business days but no later than ten (10) days after r eipt of application. The files <br /> will be held for a maximum of five business days for review- Appolntm nts should be scheduled <br /> accordingly. <br /> 3. Afile that is actively being worked on by EHE) staff may not be immedia ely availahle for review. Anew <br /> application may be submitted when the file is available. <br /> expense <br /> 4- Any file not returned in the same condition as released will be rearganl by EHD staff at the ex p <br /> of the applicant. Future file reviews by the same applicant may require $93.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must he confirmed with EHD staff. <br /> 6 . Applications received after 100 pm will be processed the next bushes day. <br />{ CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> J <br /> REVIEW PATE <br /> REVIFMP YES NO - <br /> i <br /> eno .eaxaw <br /> awma� <br />