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06/22/2004 11:59 30376119009 <br />TECHLAW INC <br />DAT EI - SAN JOAQUIN COUNTY <br />10 <br />ENVIRONMENTAL HEALTu DEPARTMENT <br />A 3Td Floor Stockton CA 95205 <br />PAGE 02/0 <br />EHD LOG NUMBER <br />JUN 2 2 2004 304 B Weber ve <br />(209) 468-3420 Fax: (209) 464.0138 Web: www.co.san joaquin.ca.uslehd <br />ENVIRONMEI`J i HEAD H <br />PERMI /SERVICES I'U�I,IC RECORDS PELF -ASE APPLICATION <br />APPLICANT: BUsINESSIAGENCY: <br />ADDRESS: <br />5 � <br />PHONE: <br />FACSIMILE 0 Lo <br />TENTATIVE* APPOINTMENT DATE: 0 eA-; L. ID,. _Time: <br />(Pleas® allow 10 businM days trop+ date of appBcation submittsl) <br />® CHECK BOX TO EXPEDITE REQUEST. $93.00 FEE -REQUEST PROCESSED INS BUSINESS DAYS <br />DATE _k4jj <br />SIGNATURE OF APPLICANT DepartmerftUse Only <br />UNIT <br />Unit 1 <br />Unit 25 <br />7Unh <br />ENVIRONMENTAL HEALTH DEPARTMENT FILESO' _2 T <br />LIDO <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT a SOOLID WASTE VENICLE <br />JOTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL O DAIRY <br />❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR G MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br />O TIERED PERMITTED FACILITY ❑ POOUSPA O LAND USE APPLICATION SITES <br />❑ TATTOOBODY PIERCING C3 OTHER (PLEASE SPECIFY) <br />® MEDICAL WASTE FACILITY iY <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 (2091464.0138 or mail o the <br />addressindicated_above• ointment for review will be confirmed <br />2. EHD will notify the applicant if any EHD files exist. An app <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 />3. A file 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 />CONFAMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />