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10/13/2003 12: 33 9252836121 AEI CONSULTANTS (SF) PAGE 01 <br /> DATE RECEIVED r. Ertl)LOG NUMBEF <br /> SAN JOAQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 C T 1 3 2003 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: W'N'VW.co.san-joaquin.ca.us/ehd <br /> i>E i'�iT% EE'ijCES C{+�PUBLIC RECORDS RELEASE <br /> QAPPLICATION <br /> I <br /> APPLICANT: f11n J111 BUSINESS/AGENCY. REI CDmL,t�Ia 1 s �I <br /> ADDRESS: ^2�0o Carni, Do' . t,y .�.eT��• 20a wok In C•.fF4k,C 0Gq 1 ----- <br /> PHONE: 9l5 YZ7�� •DDO QXT� FAA�CSS,,IMILE: 115 7�5 CJ 11 <br /> TENTATIVE'APPOINTMENT DATE: 04 2=1 , 2,00 3 Time: 1�art) <br /> �-t (Please allow 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$93 0 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE tU IBJ D O <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> o Z fU clt), ITO Unit 1 <br /> et CI <br /> O S city Unit 2 �7 <br /> 5� City tt <br /> <. street <br /> � 1 <br /> S. street 2Amdan 14 1 <br /> city CK Unit 3 l�� <br /> 6. rcet Ka. d (i <br /> 7. StKe Cry Unit <br /> e. str>et city <br /> S. Street city .Q Unit 5 <br /> 10. sl,«t City <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �FQ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT A SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK(MONITOWNGIREMOVAL) ❑ DOG KENNEL E3 DAIRY <br /> X,HA2'ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Cl PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 13 MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING 171 POOLISPA ❑ LAND USE APPLICATION SITES <br /> C3MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) '101D (RDfhZ: "SVrif L�rm l 2A <br /> I <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the listabove 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. EHD 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 EHO staff may not be immediately available for review: A neA <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 revieA <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 APROINTMENT DATE TIME FY '-j:'.• . <br /> D&E CONFIRMED " <br /> PHONE :• FAX INITIALS'" <br /> REVIEWED "YES NO REVIEW DATE <br /> ' �+o�aoxoac <br /> V W2003 <br />