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v 12/28/2003 18:38' 9252836121 AEI CONSULTANTS (SF) PAGE 01 <br /> EH0 LOG NUMBER <br /> DATE RECEIVED SAID f OAQU N COUNTY <br /> ENvIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3.'Floor Stockton, CA 95205 <br /> c.(; 3 )468-3420 Fax: (209)464-•0138 W6:wvrw.co.san-Joaquin ca us/ehd <br /> icP'dT PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSi/NESSIA(G�ENCY:_ <br /> ADDRE$S:_,F <br /> PHONE: "aD__0�5 <br /> TENTATIVE*APPOINTMENT DATE:_5Xn Time: <br /> (Please allow 10 business days from date of application submittal) <br /> El CHECK SOX TO EXPEDITE REQUEST.$93.00 F E—REQUEST PROCESSED IN 3 BUSINESS[LAYS <br /> SIGNATURE OF APPLICANT �" DATE <br /> r` Department use Only <br /> FILE ADDRESS UNIT <br /> d !� ❑ <br /> J. sweet ala ,11\It SDI's t7t Unit 1 <br /> 2 so-aet <br /> G 2 ' <br /> 3. Street I\ Unit 1 (�� <br /> Ili 4; sb*a, Irl• D .1 r1r <br /> 1 l <br /> 1!V L u Unit 3 <br /> S. 5'reet <br /> B. Strcot 1 lJ a�1.w1�G J <br /> �.r 7. seee 11 In1Q 5 c _ Unit 4 <br /> ` a. stt�t 2 a R Gt <br /> 9 2094 <br /> \. + , <br /> VN e, street 1 it a ❑ Unit 5 <br /> �� �, � • . W �l7 c <br /> ta. 3u9et <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT 3k SOLID WASTE FACILITY <br /> p SOLID WASTE VEHICLE <br /> M OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH A PKG TREATMENT PUNT <br /> TIERED PERMITTED FACILITY D MOTELJHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO/BODY PIERCING L3POOLJSPA ;KLAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIM <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.Oo 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 /> C NFIRMED APPQINTMENT.DATE .TIME <br /> DATE CONFIRMED . "`"PHONE fAX INITIQ�I S - - <br /> REVIEWED :. YES NO REVIEW DATE <br /> ' etro aacz-0ae . . <br /> yarzoc� <br />