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EHD LOG NUMBER <br /> " . NED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> o C r 2 0 2004 304 E Weber Ave 3'a Floor Stockton,CA 95205 D <br /> Efvb'iR <br /> (209)1468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.caus/elid <br /> PERF b' .'ES PUBLIC RECORDS RELEASE APPLICA.TION <br /> APPLICANT: GrG6, SUSINESSIAGENCY:_Ground Zero 4A^ kis Tnc <br /> ADDRESS: 171LIMc in S+reM+ E„scalon GA gf-320 <br /> PHONE: BsS"Ifis FACSM(LE: Sag-rtM <br /> TENTATIVE*APPOINTMENT DATE: Nov 3 2o1g Time: 9:00�^ <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—REQUFSJOCE. IN 3 1SINESS DAYS <br /> SIGNATURE OF APPLICANT �^^-^� DATE O <br /> Department Use Only <br /> FILE ADDRESS UNI <br /> Sever 900 C. L. . L. 7 ❑ Unit 1 a� <br /> a avaa c E7 Unit 2 <br /> Unit 3 �0 <br /> T. s 1 Unit 4 <br /> s. sMae city <br /> p• �I a ❑ Unit 5 <br /> ,a ewer <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> H UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OUTHER CLEANUP SITE(NON-LOP) 0 F000 FACILITY O SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL 0 DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 13 TIFRED PERMITTED PACIUTY O MOTELIHOTEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOISODY PIERCING O POOLISPA O LAND USE APPLICATION SIES <br /> 4 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(S)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(20914840138 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 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 /> 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 /> REVIEWED YES NO REVIEW DATE <br /> FNoeaal <br /> e mos <br /> Td WU8£:60 4002 OE '100 2886 828 602 : 'ON 3NOHd s?sFleuy our Z punoug : NONA <br />