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Jan 03 05 10: 03a _ Ro Nicholson 916-0-3073 p- z <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' 304 E Weber Ave P Floor Stockton, CA 95205 I P <br /> 3 ZOQ509) 8-3420 Fan: (209)464-0138 Web:wivw.CO.sanjoaquin.oa uS1ehd `/C1 <br /> i <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Bob Nicholson BUSINESSIAGENCY: RNC Environmental <br /> APPLICANT: <br /> ADDRESS: 9746 Parktree Way,Elk GrovA CA 95624 s�.a <br /> PHONE: <br /> 916-714-3073 FACSIMILE: 916-290-01.06 0 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK FKaX TO EXPEDITE REQUEST.$93.00 FEE-REQUESTPROCESSED�Robert 0.N 3 1NESS Nklwlson DAYS <br /> Dam:2Doso,.o3 o9.H:sr-0a'ar DATE <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> U <br /> MM <br /> � US ,. X7220 East Pine ❑ Unit <br /> U,5 s snit 1240 E Pine St <br /> Q1 <br /> UST a Sae 273 South Kelly Street �Lodi Unit2 11\\ <br /> NIF a star 7220 Victor RdUnit3 <br /> 32 N Cluff <br /> N� C 100 S Cluff AveUnit 4 <br /> r00 S.Beckman <br /> N I F e. svaae 902 Industrial c Lodi Unit 5 <br /> 9. &act <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES V <br /> SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE VEHICLE , <br /> OTHER CLEANUP STE(NON-LOP) FOOD FACILITY DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL <br /> CHICKEN RANCH PKO TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR MOTEUHOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY POOLJSPA 5 LAND USE APPLICATION SITES <br /> TATTOOBODY PIERCING POOLI (PLEASE SPECIFY) <br /> MEDICAL WASTE FACILITY OTHER <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(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicaM'd any EHD files exist An appointment for review will beappliCenFirm files <br /> approximate) five business days but no later than ten(10)days afterreceipt of I be cheduled <br /> ion. The <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. 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 <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 610 da-04-006 <br /> elvlaoa <br />