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06/10/2003 07:55 9252836121 <br />CJD/n�i [nn.s Au:1H 4640138 <br />"'"IQ^"•,•,.• ENVIRONMENTAL HE.' I <br />V nD SAA[ JOAQUIN COUNTY PAGE ez <br />ENVIRONMENTA[_ HEALTH DEPARTMENT <br />VY <br />304.EAST E13ER AVENUE, THIRD FLOOR <br />JUN 1 0 2003 STOCICTON CA 95202 <br />(2f,'9) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESSIAGENCr <br />ADDRESS <br />PHONE �� r l 1;�: — -• <br />FACSIMILE Q� 2 <br />TENTATIVE" APPOINTMENT DATE <br />—apE' ,I bn <br />(Neaac plve 7 to 10 bUSft)gS . days from date of a TIh1E <br />I�lllication cu!:+nc :taq <br />CHECK BOX TO QCPEDrM REQUEST _ $99,08 FEE - REQUF 3T PROCESSED IN 3 BUSINESS DA'1r3 <br />SIGNATURE OF APPLICANT CD,t,TiE C2 b / <br />;� d s� <br />7 <br />AEI CONSULTANTS (:3F) <br />PAGE 02 <br />5. <br />FILE ADDRESS ` THIS S liE icHi F;TAFF USE <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />JtlN 19 2003 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT SUL III WA iTE FAGi1U1Y <br />OTHER CLEANUP SITE (NON•LOP) ❑ FOOD I! ACIL ITY d SOU'1 WA. iTC VE144CLE <br />UNDERGROUND TANK (MONrTORING/RIEMOVAL) ❑ DOG IQ::NNEL b DAIR•i• [ <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ P+;`- TREARAENT PLANT <br />❑TLERfD PERMn7ED FACILrry La beOTEUHOTEL 0 PLI"F'ER 1`-4;UCIVYARE1CHEr4 TOTLETS <br />❑ TArrootaODY PEIRCING 0 DOOLIS PA ❑ LAN USE APp1LICAlinly SnEs '5 <br />❑ MEDICAL WASTE FACV Y Sq OTHER (PLEASE SPECIFY) p ,,} » 7s^, r<_��( <br />1. List up to ten addresses in the space above. Select the type(s) of t1les � mr n th r. Iw•t above by checking <br />the appropriate box(es). At least one file type MUST be selected_ -I-'ax t1L209) ,16.4-0138 or mail to the <br />address indicated above. <br />2. EMD will notify the applicant if any EFID files oxist An appointment for re,riew will be otmfimied <br />approximately five business days but no later than ten (10) days after rvae+ipt cg application. The file,, - <br />will behold for a maximum of five business clays for review. Appointtn(!ni:s shc)uli be sched;Jled <br />accordingly. <br />3. A file that is actively being worked on by EHL) staff may not be immediately av-ilable 'fol- ravi+_ . A nnw <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as raleas.ed will be reor+,ganL;ecl by HFID staff at this ezcpense <br />of the applicant. Future file reviews by the s-pme applicant may require a $89.05 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />S. Applications received after 3:00 pm will be processed the next buSlness, day. <br />CONFIRMEo APPOINTMENT DATE _-- - TIME <br />DATE CONT-fRMED P111ONE FAX I'NIT141L$ <br />REVIEWED YES NO REVIEW DATE <br />6HD 48b30Gi -_—_,_ <br />v2sa +08 <br />0A <br />U3 <br />noftm. <br />