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04/07/2003 17:11 92528" ?1 AEI CONSULTANTS';F i PAGE '211. <br /> EWIRONNENTAL `W4-Tj1 PAGE Z11 1� <br /> EHpLOG NUSFR <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> APR 0 8 2003 304 ENVIRONMENTAL DIVISION <br /> AST WEBER AVENUE,THIRD FLOOR <br /> 33 <br /> ENVIRONMENT STOCKTON GA 95202 ' . <br /> ENVIRONMEN► HEALTH, tag 468-3420 o� �� I- <br /> PERMIT/SERVIABLIC RECORDS RELEASE APPLICATION <br /> �.rl] {' � ��u���� <br /> kH <br /> PLICANT �' h � � SU,4NESWAGENCY � CT1SAPR 0 8 2003 <br /> DRESS CCU � W ;�n�,�NT HEALTH <br /> ON <br /> E1n3 D,lZL - FACSIMILE q2 rL� ( 1! _ PERMIT/SERVICES <br /> TENTATIVE*APPOINTMENT DATE `�f k�/ TIME 140•.1}� Y_ [!-'()"`�3 <br /> (Please give 7 tai b iness days from date of application su , iltal) I jc�r1 5� <br /> + 31 CHECK BOX TO EXPEDITE REQUEST-$89.64tF�E(E�-RE VEST PROCESSED IN 3 BUSINESS OA'la^ Un� <br /> SIGNATURE OF APPLICANT j"` DATE <br /> THIS SIDE VM0 STAFF USE ONLY <br /> FILE ADDRESS PROGRAI4 ELEMEIM� SEARCH <br /> ltbt9 AJ 0 <br /> "Do 3, _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT p SOLID WASTE:Fd�CILITY <br /> ❑ FOOD FACILITY 0 soi.ID WASTI:VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) <br /> UNDERGROUND TANK(MONi"RING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH V PKG TREATMENT PLANT <br /> O 'nERED PERMITTED FAMITY ❑ i4OTEUHOTEL ❑ PUM PER TRUGKIYARD/CHEM TOILETS <br /> wAsTB FACILITY ❑❑ POOUSPA Q N LAUD USE APPLICATIOSITES <br /> O MEDICAL AS <br /> O TATTOO PEIRCp CTHLR(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above- Select the type(s) of files fnam the li,t above by crheckins <br /> the appropriate box(es). At toast one file type MUST be selected. Fax to 209 aE-Wtd)138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of:a;eplication. The files <br /> will be held for a maximum of five business day$for review. Appointmelits should be scheduled <br /> a"lurd i ngly, <br /> 3. A file that is actively being worked on by EHO staff may not be immediately available for review. A nev <br /> application may be cubmlttad whan the file is available. <br /> 4, Any file not returned In the same condition as released will be reorganized by EHD staff at the exl�prlsc <br /> of the applicant. Future file reviews by the same applicant may require z 589.00 deposit prior to reviev <br /> 5. *TENTATIVE appointment dates mtmt be confirmed with EHD staff_ <br /> 6. Applications received after 3:04 pm will be processed the next buslnw-4 day. _ <br /> TIME Post-It"Fax Note 7671 <br /> CONFIRMED APPOINTMENT DATE ,b <br /> DATE CONFIRMED PHONE FAX <br /> REVIEWED YES NO REVIEW DATE •_,_•==ir!i phone# <br /> ,rs� <br />