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V 12/28/2003 18:38 9252631 AEI CONSULTANTS) PAGE 01 <br /> EHO LOG NUMBER <br /> DATE REGENED SAN JOAQUIN COUNTY <br /> 31 FF _ ENVIRONMENTAL fIEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Flobr Stockton, CA 95205 <br /> 0H C 3 Q")468-3420 Fax: (209)4640138 Web:Wivw.cO.san-joaquirLmus/ehd <br /> OiVlV;cP)i BUBLICRECORDSRELEASEAPPLICATION <br /> APPLICANT: Y` ausiNESSIAGErrN,,CY: <br /> ADDRESS: Vl l 3—(p( <br /> PHONE: <br /> 1(5 FACSIMILE: �G^� — <br /> TENTATIVE*APPOINTMENT DATE: (Sexn j 2-4, Time:• I " M <br /> (Please allow 10 business days from date of applloatlOn submittal) <br /> 0 CHECK BOX TO EXPEDITE REQUEST 493.00 If <br /> E—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Lr.. DATE <br /> Department use Only <br /> i <br /> WbFILE <br /> �AJD"DRaE�S1Sw <br /> \�GGG i11 <br /> \ <br /> UNIT <br /> 1-I0 Wt 5or\ a It Un <br /> it 1 <br /> 2. Saed <br /> Unit <br /> 3 S6 WI We <br /> ,1 <br /> �•V 9., swat 'I i� G esw 2 2 s R cl <br /> t• sva I t l'1 tnJf 5 G _ <br /> 'IA M Unit 4 <br /> [3 Unit 5 <br /> KY <br /> �� ta. Sunet •� Z W SD 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �j UNDERGROUND TANK(UST)CLEANUP SITE(LOP) U HOUSING ABATEMENT 3�SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGfREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 13CHICKEN RANCH 5k PKG TREATMENT PLANT <br /> X HAZARDOUS WASTE GENERATOR <br /> R) TIERED PERMITTED FACILITY O MOTELMOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> d TIERS DPERMI1BODY PERMITTED <br /> O POOUSPA X LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIE'!) <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. Eg tc(2091464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD wili nofify the applicant if any 1 HD 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 /> 3. Afile that is actively being worked on by EHD staff may not be immediately available for review. A ner <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 expens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie <br /> 6. *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 /> i <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE 'FAX INITIALS' <br /> REVIEWED _ , °YES NO REVIEW DATE <br /> ENO{ 1406 - <br /> TNf2000 .' <br />