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05/09/2003 14:48 9255517464 ENVIROFORENSICS PAGE 01/01 V 4e 003 Im PATE RECEWeo _ tiWO LOG NUMBER 1 SAN JOAQUIN COUNTY ENVIRONMENTAL, HEALTH DEPARTMEN r 304 EAST WEBER AVENUE, THIRD FLOOR M Ay 0 0 Li103 STOCKTON CA 95202 (209) 468-3420 PUBLIC RECORb0 GiELEASE APPLICATIOP�1 APPLICANT ®USINESSIAGENCY_j�� ADDRESS „ y� ►-',�_L��_ �'f J G- _ PHONE S — °-%fir% FACSIMILE. TENTATIVE' APPOINTMENT DATE » !! TIME (Please give 7 to 10 busln®ss tltya from date of application submittal) _ _ I I CHECK BOX TO EXPEDITE REQUEST - SIGNATURE OF APPLICANT • PROCESSED IN 3 BUSINESS DAYS LAA1 — .. 1 .O ., M/IJNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOL ID'NAS'l lc FAC:IUTY n niini�lii ❑ FOOD FACILITY ��tu!mNI l�u s r -,�-, -- r ill la�L� 111' i ENVIRONMENTAL HEALTH DIVISION FILETS 9 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Pax to (2(.? 494-(-01 i5 or mail to the address indle t d above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will he confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHO staff may not be Imnllfdiafiay available for review. A novo application may be submitted when the file is available. 4. Any file not returned in the same conditlon ax. released will be reorganIznd 9-iy E:iD :staff at the expense of the applicant. Future file reviews by the same applicant may require a $119.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff, 6. Applications received after 3:00 pm will be processed the next business (jail. s CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX I141T1ALS REVIEWED YES NO REVIEW DATE 3r2MOO2 M/IJNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOL ID'NAS'l lc FAC:IUTY 1597HER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY Cl SOLID WAST E VEHICLE UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL Cl DAIRY C7 HAZARDOUS WASTE GENERATOR CO CHICKEN RANCH Cl PK(: TREATMENT Pt.ANT ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PURIPE R TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEIRCING ❑ POOLISPA Cl LAPD USE A-PUCA;nON SITE$ ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY)__----_____ 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Pax to (2(.? 494-(-01 i5 or mail to the address indle t d above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will he confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHO staff may not be Imnllfdiafiay available for review. A novo application may be submitted when the file is available. 4. Any file not returned in the same conditlon ax. released will be reorganIznd 9-iy E:iD :staff at the expense of the applicant. Future file reviews by the same applicant may require a $119.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff, 6. Applications received after 3:00 pm will be processed the next business (jail. s CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX I141T1ALS REVIEWED YES NO REVIEW DATE 3r2MOO2