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V 12/28/2003 18: 38 925283`21 AEI CONSULTANTF ) PAGE 01 <br /> . EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> _ Ert c�itorrn�rrrAx HEAT x�a DERARZME1vT <br /> 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> C 3 4 Qom) 468-3420 Fax: (209)464-0138 Web: w+vw.co.saa_joaqujrLca_us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> r. 1^ �D11511�Q(� <br /> APPLICANT: V Y . BUSIjNES�SfAGE+N,CY: <br /> ADDRESS: <br /> 5174f�. -) FACSIMILE: <br /> PHONE:(� i <br /> TENTATIVE*APPOINTMENT DATE: (sm (Z-)3 —Time:_IDdM <br /> (Please allow 40 business days from date of application submittal) <br /> In CHECK BOX TO EXPEDITE REQUEST-$93.00 FIE—REQUEST PROCESSED IN 3 BUSINESS DAYS 3� <br /> A-- DATE 47 <br /> SIGNATURE OF APPLICANT <br /> Department Use Only <br /> i <br /> UNIT <br /> FILE ADDRESS <br /> \�.\ I 1. sveet �^i . 1 •W t $D7"3 G ❑ Unit i <br /> It <br /> 2 <br /> 3. S�eN � ,Wl Wll G it Unit 2 <br /> s. seen Wa G Unit 3 <br /> �f 9. Slrcc� i 1 � yo <br /> L r, sro� U 11 t 1eS G <br /> :Uil4C5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tl HOUSING ABATEMENT X SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) F000 FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ <br /> M OTHER CLEANUP SITE(NON-LOP) CI DOG KENNEL ❑ DAIRY <br /> PE UNDERGROUND TANK(MONITORINGIREMOVAL) El CHICKEN RANCH 171 <br /> PKI TREATMENT PLANT <br /> kHAZARDOUS WASTE GENERATOR p MOTEUHOTEL InPUMPER EM TOILETS <br /> B) TIERED PERMITTED FACILITY p PppUSPA ;K LAND USE APPLICATION SrrES <br /> d TATrOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> t, List up to ten addresses in the space above. Select the type(s)of files from the list above by checkinc <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0738 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any <br /> y EHD files exist An appointment <br /> after receipt ff ar review ipplication he files <br /> approximately five business days but no later than ten(t 0) y erreishould be scheduled <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. <br /> 3. Afile that is actively being worked on by EHD staff may not be immediately available for review. Ane <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 confinned with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> . ...,71ME ::.. <br /> DATE CONFIRMED .-" PHONE FAX <br /> INffIALS ' <br /> REVIEWED YES NO REVIEW DATE <br /> . 777 <br /> END.aazaoa - - <br /> u3cem - <br />