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04/04/2005 15:53 2e93G94rNEIL ANDERSON EP�-RO PAGE 132/0 <br /> i, DATE RECEIVED C. 1-HD LOG NI ER <br /> * � � .I ` <br /> SAN JOAQUIN COUNTY , <br /> ENVIRONMENTAL ITEA_LTH DEP,ARTI!'I;ENT h <br /> 304 E Webcr Avc 3d Floor Stockton, � <br /> (209) 468-3420 Fax: (209) 464-0138 Web: wwvsr.co.san-J <br /> SAM UN <br /> J0 ATY <br /> PUBT-11C RECORDS RELEASE AP �.4rT �t,_ .. <br /> I <br /> APPLICANT; �V-T BUSINESSIAGENCY: <br /> ter- IIM <br /> ADDRESS: <br /> F _I <br /> PHONE: `''1—310-7— 10 1 FACSTMILE: <br /> i 1 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please alfow 10 business days from date of applic tion submittal) <br /> CHECK BOX TO EXPEll REQUEST-$93.00 FEE–REQUEST PROCESSEb IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT tA <br /> k DATE "t <br /> !� Davartment Use ON <br /> UNIT <br /> cld� <br /> Unit 1 <br /> 2. Strut G /T .. / f rAl I J 1Z I <br /> 3. Slreel �� cn ,� r �! f►t Unit 2 yf <br /> a Slreel G I�` 0 <br /> S. Sweetic <br /> ye <br /> !g!q I {�r i �� A-- - � <br /> Un' 3 <br /> l� _ <br /> t. street 51 _ Ger. i Unit 4 <br /> Cil w <br /> G. Street _ ; <br /> I , <br /> a. sneer ct! ❑ Unit 5 <br /> T I <br /> ,o, sneerW&W a"t <br /> ENVIRONMENTAL, HEALTH DEPARTMENT FILES <br /> ,l <br /> Ilk UNDERGROUND TANK(UST)CLEANUP STTE(LOP) d HOUSING ABATEMENT SOLID WASTE Fgl:It.1TY <br /> ,ll OTHER CLEANUP SITE(NON-LOP} rj FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Rb UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNELi 11 DAIRY 3 <br /> Pt, HAZARDOUS WASTE GENERATOR CICHICKEN RANCH E3 PKG TREATMENT PLANT <br /> 90 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL '+ Ct PUMPER TRUCKfYARDICHEM TOILE � <br /> 0 TATTOOlf3ODY PIERCING ❑ POOLISPA } ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) R _ <br /> 1. List up to ten addresses in the spacer above. Select the types)of files from the list above by check <br /> the appropriate box(es).'At least one file type MUST be Select6d. Fax W209)464-0138 or mail to tt <br /> address indicated above. �# <br /> 2. EHD will notify the applicant 1f any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) dais after receipt of application, The fill <br /> will be held for a maximum of five business clays for review_ Appointments should be scheduled <br /> accordingly. '7 <br /> 3. A fiTe that Is actively being worked on by EHI]staff may not be;�Immediately available for review. A r <br /> application may be submitted when the file is available.l� ii <br /> 4. Any file not returned in the same condition as released will be reorganized by.EHD staff at the exper <br /> i of the applicant. Future file revfews by the same applicant may require a$93,00 deposit prior to revi <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> } B. Applications received after 3:00 ern will be processed the nextl'business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRME=Dy <br /> PHONE i <br /> FAX INITIALS <br /> REVIEWLD YES No REVIEW DA'TE <br />