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/11/04 FRI 15:38 FAX 9167013 KLEINFELDER a00 <br /> EHD LOG NUMBER <br /> DATE(RECEIVED SAN JOAQUIN COUNTY <br /> LN �\`' DI ENVIRONMENTAL HEALTH DEPARTMENT <br /> a 304 E Weber Ave 3 r Floor Stockton,CA 95205 <br /> JUN 1 1 20 <br /> 209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquinca.us/ehd <br /> ENViRommENT HEALTH PLIC RECORDS RELEASE APPLICATION <br /> RFRVIMSERVICES „n ( 1 <br /> APPLICANT: ..qq��}P^^'rr��or nI 110❑re- BUSINESS/AGENCY: Iii1�4dAer'} rriC <br /> ADDRESS: t_M7 riff- Grr)e, 5afX-0- eM n-� �' ��827 <br /> PHONE: �g1 - 1'7Oi -FACSIMILE: (91(,) 3ta6-7013 <br /> N - <br /> TENTATIVE"APPOINTMENT DATE: yogr �I�� CM YPI1WTIme: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT Department Use Only <br /> U <br /> NIT <br /> FILEADDRES <br /> rr O A. nY'O RSU�e <br /> rr �� � La}l�ro?00cfty <br /> frc2+� �- <br /> . fi^ <br /> a <br /> e. weal� Unit <br /> 7, ty <br /> St ed <br /> e. senaqlq e r 5 <br /> 9. Strad <br /> to. Sbea <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> PI HOUSING ABATEMENT a SOLID WASTE FACILITY <br /> ® UNDERGROUND TANK(UST/CLEANUP SITE(LOP) 13 FOOD FACIL1 Y El WASTE VEHICLE <br /> C4 OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL a DAIRY <br /> a UNDERGROUND TANK(MONrrOMNG/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLtSPA la LAND USE APPLICATION SITES <br /> Cl TATTOO/BODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> he <br /> files from <br /> list aboye <br /> 1 hetup to ton appropriat addresses <br /> box(es). In the At least one fiace le type MUST ove. Select tbe selected. Fax to(209)464-0138 orbmai to the <br /> address indicated above. les exist. <br /> 2 EHD <br /> rwiilm ably the <br /> e business days but Ofi no later than t n (10)days after receipt f apointment for review ipplication The files <br /> app Y ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <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 /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX" INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EW Ia-02-006 <br /> V w <br />