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11/05/2004 16:20 92528' 1 AEI CONSULTANT "ASF) PAGE e2 <br /> EHD LOG NUMBE <br /> 1C' 1' ED SAN JOAQUIN COUNTY <br /> 7EN MONMYNTAL HEAx.TR DEPARTMENT <br /> P 5 2004 304 E Weber Ave 3rd Floor Stockton.,CA 95205 <br /> 0 Fax. (209)464-0138 Web: w'rw.co.san joaquiz ca.vslek�d <br /> 1 L: s.i`vli 1/SERVICE <br /> SPUFLXC RECORDS.RELEASE APPLICATION <br /> APPLICANT: �` YI"ifli 1 BLISIJII~SSJAGI=NCY(: SU� S <br /> ADDRESS: YS 1� W _Air `T��"t 511 <br /> PHONE: 111a`95 Ot3� FACSIMILE• <br /> TENTATW AP OINTMENT DATE: f" Timw: <br /> I <br /> ase allow 10 business days from date of eppliostian subrriWAD <br /> CH K BOX I QUEST-$93.04 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE awl <br /> SG UQ ' {CANT <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. WeeL U PA ~ .W ill SO Tt a ❑ Unit 1 a <br /> x- sit d <br /> 9. slraeL i .Sierr+R to �� _ Q Unit 2 <br /> Ott <br /> s. sLrCet `1 .O WUnit 3 <br /> ( <br /> 8. Street a4i 1 0 <br /> it <br /> l' Urlit 4 <br /> el sapr CRY <br /> 7. sveet <br /> a. sLraet2-' IS <br /> CRY <br /> s. SlreeL x? G a �. [a Unit 5 <br /> env <br /> to. stmt <br /> ENVIRONMENTAL HEALTH p M <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LAP) n HOUSING ASAT . f SOLID WASTE i=ACiLrTY <br /> OTHER CLEANUP SITE(NON-LOP) 0.FOOD FACILITY 0 SOLID WASTE VF=HICLE <br /> f� UNDERGROUND'TANK(MONrrOR1NGIREMOVW.) 0 D(>G'!C>=NNEL C1 DAIRY <br /> trRl�IIT <br /> p <br /> )Z i{AZARDOUS WASTE GENERATOR d ,CHICKEN RANC14 C1 PTREATMENT PLANT <br /> T1EREi1 TED FACILITY Ll MoTEUHOTEL G pU(INIPERTRUCKlY,gR17JCHEM rbILETS <br /> 0 POOLISPA 'Cl LAND USE APPLICATION SITES <br /> E:3 TATTt) r-Rm PIERCING <br /> 0 MEDICAL WASTE FACILITY d OTHER{PLEASE SPECIFIC <br /> 1, List Up to ten addresses in the space above. Select the types)of files from the list above_by checking <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. EHi)will notify the applicant if any END 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 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 5HD staff'at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 dep riot to review. <br /> 5. *TENTATIVE appointment dates must be conflrmed with EHD staff. <br /> S. Appiications received after 3:00 pm will be processed the next business day. <br /> 1 <br /> 4 <br /> � lMl�.CONFIRMED T DAT>w xINTMEN <br /> :. <br /> `PHONE:. .FAX,. . ' . IItfCCtl :S:'°f__ .:•":;o.';' 1 <br /> DATE CONFIRMi=D F • ' <br /> REVIE=tNI=!] YES NO h REVIEW DATE € <br /> 8t9r1943 � <br /> ' E <br /> I <br />