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04/05/2004 09:27 <br />DA;uE RECEWED <br />V — <br />APR 0 7 2004 <br />92512836121 <br />(Z09) 468-34 <br />ENIIJ RIJivi : ; . <br />Pt„\, D1 <br />APPLICANT: <br />ADDRESS: <br />AEI CONSULTANTS (SF) <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL )HEAL'T'H DEPARTMENT <br />304 E Weber Ave P P1oor Stockton, CA. 95205 <br />0 Fax: (209) 464-0138 Web: www.co.san joaquin.ca us/ehd <br />C RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY: YI <br />PAGE 01 <br />EHD LOG N �= <br />PHONE: 0 FACSIMILE: 916,;6-5 �1 _ <br />TENTATIVE* APPOINTMENT DATE. "1 I Time: <br />(Please allow 10 bt[9iness days from date of application submittal)I 7w! <br />.__ <br />CHECK SOX TO EXPEDITE QUEST - $93.00 FEE —REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SI, <br />3NATURE OF APPLICANT <br />NV DA' <br />FILE ADDRESS <br />s. Street 1(DOS- X35, <br />o V � <br />2 Sxet G4 0 <br />aty[ <br />a. sit 0 00 rd <br />c1ty <br />f. s,rrse `its CP,ri rUly <br />S, Str^M 95 5,} r St <br />— Dov)r7 rs L1cZiYet <br />e. s i �1 S, El aor o <br />cry(� <br />cel _ <br />U <br />IrM <br />OtyII p_ <br />10. Sam <br />city <br />UNDERGROUND TANK (UST) ( <br />OTHER CLEANUP SITE (NONd <br />UNDERGROUND TANK (MONn <br />HAZARDOUS WASTE GENERA <br />TIERED PERMITTED FACILITY <br />TATTOO/BODY PIERCING <br />❑ MEDICAL WASTE FACILITY <br />1. List up to ten addr( <br />the appropriate boy <br />address indicated <br />2. EHD will notify the <br />approximately five <br />will be held for a m <br />accordingly. <br />3. Afile that is activel <br />application may be <br />4. Any file not returne <br />of the applicant. R <br />5. *TENTATIVE appoii <br />6. Applications receiv <br />7E `1 <br />Department Use Only <br />UNIT <br />❑ Unit 1 <br />Unit 2 <br />n uni <br />nit 4 <br />g 20 4 . <br />❑ Unit 5 <br />ENVIRONMENTAL. HEALTH DEPARTMENT FILES*-- <br />UP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br />ElFOOD FACILITY SOLID WASTE VEHICL. . <br />E `� . <br />WREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />❑ CHICKEN RANCH PKG TREATMENT PLANT <br />0 MOTEUHOTEL d PUMPER TRUCKrYARD/CHEM TOILETS <br />❑ POOL/'SPA Zk LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY) <br />In the space above. Select the type(s) of files from the list above by checking <br />At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br />aplicant if any EHD files exist An appointment for review will be confirmed <br />isiness days but no later than ten (10) days after receipt of application. The files <br />cimum of five business days for review. Appointments should be scheduled <br />being worked on by EHD staff may not be immediately available for review. A new <br />ubmitted when the file is available. <br />in the same condition as released will be reorganized by EHD staff at the expense <br />ure file reviews by the same applicant may require a $93.00 deposit prior to review. <br />ment dates must be confirmed with END staff. <br />J after 3:00 pm will be processed the next business day. _ q., RR <br />CQNFIRMED APP0INTME T DATE TIME <br />DATE CONFIRMED .:..' "PHONI ; 'FAX INITrALS <br />REVIEWED _ . ' YES NO REVIEW DATE <br />