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v 12/28/2003 18:38 92528?F121 AEI CONSULTANTS 'F) IPAGE 01 <br /> - EHO LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"dFloor Stockton, CA 95205 <br /> OEC 3 Q. �)468-3420 Fax: (209)464-0138 Web:w w.co.san-Joaquin taus/ehd y <br /> EiVvlRO°gid V'�PJT r,� ,1_� PUBLIC RECORDS RELEASE APPLICATIIO)N� <br /> APPLICANT: Yl Y' BUSINESSSIAGENCY:ADDRESS: rr�1k�=B i 1PHONE:C"IYl <br /> FACCSIMILE: <br /> TENTATIVE:.*APPOINTMENT DATE:.5 un 1 Z4 -Time: <br /> (Please allow 10 business days from date Of 2ppI1G3U0n submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST 493.00 If E-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> A . DATE 3D ^ <br /> i <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> \� 1. sneer �41d II 11 ,W L SOrr Q CI!, 11 ❑ Unit 1 <br /> "� 2 6aaet L ( I V"f.. G <br /> \ 11 <br /> Wt w� G Unit 2 V ; <br /> 4: SYear `I IV. D W <br /> s. 5ree Wa G Unita \/1,A� J� <br /> 1 1 •j���G ` <br /> '-.,I r, sreet 111 1 M.S Cry Unit 4 S <br /> \ , e. 6tmd 'f. 2- 1 n r + e <br /> V� 1M.s 1 it <br /> Qty Unit 5 <br /> �� �a. sveat •, 2 W SD O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) U HOUSING ABATEMENT 3k SOLID WASTE FACILITY <br /> 1Z OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH X PKG TREATMENT PLANT <br /> $1 TIERED PERMITTED FACILITY O MOTELMOTEL ❑ PUMPERTRUCW'�ARD/CHEM TOILETS <br /> rj TATTOOIaODY PIERCING ❑ POOLISPA ;K LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. 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)464-0138 or mail to the <br /> address indicated above. <br /> 2. END will notify the applicant if any EHD 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. A file that is actively being worked on by EHD staff may not be immediately available for review. A ne <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 /> 5. *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 BATE , <br /> TIME <br /> DATE CONFIRMED ` : "`PHONE ` FAX INITIALS' r <br /> REVIEWED YES NO REVIEW DATE <br /> enp 1a,azaoa <br /> varzeoa <br />