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04/04/2005 15:53 2093694--''l NEIL ANDERSON EIQ PAGE 02/0 <br /> GATE REGEIVED + �••� FEND LOG Nl ER <br /> Q <br /> SAN JOAUIN CO'UNTX <br /> EN'VIRONMEN'TAL I .FA,LTH DEPART1'Ii 'NT 7 <br /> r <br /> 304 F Weber Ave 3d FloorStockton,, <br /> 6�.9 <br /> (209) 4683420 Fax: (209) 464-0138 Web: www.co.sat Iii .ca4us� ':�� <br /> 5 A N o rf o tll�'f 1r , <br /> P�T,,JC RECORDS RELEASE AP ��7!tL., <br /> APPLICANT; yT BUSI'NESSIAGENCY: i <br /> ADDRESS: _ �'� .L TTTT t lA '1 ♦ j -- i] <br /> PHONE, 0-7 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time; <br /> t—t (Please allow to business days From date of application submittal) <br /> I-^I CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> E t panem use ON <br /> FILE DRESS / UNIT <br /> +, Street -1c'1 <br /> Jr�.4 q:q �p�,ti�'i, crw f/ 1) rv%. knit 1 It <br /> kA�5 Unit 2 <br /> �. Slreel GII iAw <br /> f. street _ cit nn__ fF• JrU t 3 <br /> a. strcc, s e �a <br /> 7, strgct Z*(fi1,0 q0A S City <br /> • Unit 4 - <br /> GN(e <br /> DIV ❑ unit 5 <br /> te. street T <br /> • <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WL UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT P0 SOLID WASTE FACILITY <br /> ,-FM OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Rb UNDERGROUND TANK(M ONITORINGIREM OVAL) 0 DOG KENNEL ❑ DAIRY <br /> Pal HAZARDOUS WASTE GENE=RATOR ❑ CHICKEN RANCH E3 PKG TFt1=ATM ENT PLANT <br /> g' TIERED PI=RMITTED FACILITY ❑ MOTELIHOTI=L ❑ PUMPER TRUCKIYARDICHEM TOILE <br /> ❑ TATTOOlaODY PIERCING ❑ POOI-1SPA ❑ LAND USE APPLICATION srrEs <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(5)of files from the list above by check <br /> the appropriate box(es).'At feast one file type MUST be selected. Fax-to 1299)46_4-0138 or mail to V <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 oftir receipt of application. The fill <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 r <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 exper <br /> of the applicant. Future file revievrs by the same applicant may require a$83.00 deposit prior to revi <br /> 5. *TENTATIVE appointrnent 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 DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> PEVIEWED YES NO REVIEW DATE <br /> - <br /> �yry <br />