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AUG, -17' 04 (TUE) 14:08 VERSAR, INC. TEL:9169622678 P. 001 <br /> n <br /> pn SAN JOAQUIN COUNTY <br /> �rID LOG NUMBER <br /> EN <br /> ENVI.RONMTAG HEALTH IDEPARTM,NT <br /> AUG 17 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> HEALS <br /> 09)468-3420 Fax: (209)464-0138 Web:wivw.co.san-joaquin,ca.Us/ehd <br /> P r ; ;,T;CERVICESPUBLIC RECORAS RELEASE APPLICATION <br /> APPLICANT:.iP 1 l C-Mr'V 'leV BUSINESS/AGENCY: �lr r-, Inc. <br /> ADDRESS: A U a(i Age- �U3: <br /> FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE--NA0QAnjj9VOI�;L3 ar1)9TIms: j QQ= <br /> (please allow t0 business days from data of appllcatlan submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$03.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1511-7 0 <br /> OenaAment Use Only <br /> LEA DRESS UNIT <br /> ck 5T - 2� lt1 <br /> 2 6 G U` � A)p Unit 1 <br /> 4. svw L .n C ��rrq Unit 2 <br /> Cl SEN,-� T O�5 �i 1 <br /> s sw« c Unit 3 <br /> 8. Strom Gr <br /> I <br /> Simi c <br /> 64ee1py <br /> a s CR q Unit 5 <br /> CN <br /> ✓ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> V rp UNDERGROUND TANK(UST)CLEANUP BITE(LOP) t7 HOUSING ABATEMENT CJ SOLId W I <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY CI SOLID WASTE VEHICLE <br /> WUNDERGROUND TANK(MONITORINGIREMOVAL) M 000 KENNEL P DAIRY <br /> ge HAZARUOUS WASTE GENERATOR P CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY n MOTELIHOTEL C7 PUMPER TRUCK/YARD/CHEM TOILETS <br /> CI TATTOO/BODY PIERCING 13 POOL/SPA Q LAND USE APPLICATION SITES <br /> G MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above.,Select the type(s)of files from the Ilst above by checking <br /> the appropriate 130X(85). At least one file type MUST be selected. Fax to,(2o91464.0138 or mall to the <br /> address Indicated ppove. <br /> 2. EHP will notify the applicant If any EHD flies 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. 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 /> fi. '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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 00 4"t4" <br />