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04/05/2004 09:27 9252836121 AEI CONSULTANTS (SF) PAGE 0 <br /> DAY`JE RECNVED EHD LOG <br /> X11' \C SAN JOAQUIN COUNTY <br /> ENVIRONINUNTAL HEALTH DEPARTMENT <br /> APR 0 7 2004 304 E Weber Ave 3'l MOOT Stockton, CA 95205 <br /> ENViROiv <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca us/ehd <br /> � <br /> `N_ PUBLIC RECORDS RELEASE APPLICA'HON <br /> c�rl <br /> APPLICANT: A) BUSINESSIAGENCY: <br /> ADDRESSS-^f� n t2� <br /> PHONE:_S Y )3 (9000 FACSIMILE: fZ5 <br /> TENTATIVE'APPOINTMENT DATE:A 0 Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$03.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS p <br /> SIGNATURE OF APPLICANT DATE <br /> DePartmEM Use Only <br /> ©.\ p• FILE ADDRESS UNIT <br /> i +, s u� (035 ,�) O a SI"oc�c4un [] Unit1 <br /> Z a 4 <br /> a. 7 5. EI Dora ci n G �) <br /> A. 4vr. -tilS. CdvI er it - /�d/n'J G.� Unit 2 <br /> s. so- 25 5. St Unit 3 <br /> e. 141 S,EI DofA.do a ,-1i <br /> u <br /> a <br /> !I n <br /> er a I <br /> nit 5 <br /> city <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> §i(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON•LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 9 PKG TRFATMENT PLANT <br /> $ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> jj TATTOOIBODY PIERCING ❑ POOLISPA U,LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFIC <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 204 464-0136 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 application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 31 Afile that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRM ED PHONE FAX '` INITYALS' <br /> REVIEWED YESNO REVIEW DATE <br /> eno�s�cos <br /> enrzoo� <br />