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11/17/2003 16:16 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> �pug1T E''�F�I�CEO�.- cnv <br /> W���I�I \1V`iSD SANJOAQUINCOUNTY <br /> ", `/ ENVIRONMENTAL HEALTH DEPARTMENT / <br /> N 0 V 1 7 2 304 E Weber Ave 3`1 Floor Stockton,CA 95205 I <br /> J)468-3420 Fax: (209)464-0138 Web:vrww.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH ELIC RECORDS RELEASE APPLICATION <br /> �pFannlTr�4vlrf-c - — <br /> APPLICANT: Didrik Johnck BUSINESSIAGENCY: Geologica <br /> ADDRESS: 594 Howard Street, Suite 400 <br /> 415-297-7903 " <br /> HONE: FACSIMILE: 772-402-4834 ' <br /> TENTATIVE'APPOINTMENT DATE: 'rime: <br /> rq'/ (Please allow 10 business days from date of application submittal) <br /> � GHECK BOX TO EXPEDITE REQUEST.S 00 F REQUEST PROCESSED IN 3 BUSINESS DAYS 11/17/03 <br /> SIGNATURE OF APPLICANT ^^ DATE <br /> Deoanment use only <br /> FILE ADDRr�S UNIT <br /> slr.N 800 Mellow IV12nteca CAa ❑ unit 1 <br /> z. aVeel 3 <br /> 1. sueel Moffat blvd_ <br /> ci 11, <br /> ,,,,,, bb Moffat Blvd city ~ <br /> 5. am elclu ' L <br /> a,.963 Iviorrat B Vd. ManjQQaCA G <br /> 7. 30r 1 LI 1 �.Jnit 4 <br /> UUUU <br /> B. 3lreel CI <br /> 9. 9lreel city ❑ UOIS 5 <br /> o. S reel <br /> GI ^ r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 SOLID WASTE <br /> icon: <br /> " UNDERGROUND TANK(UST)CLEANUP STYE(LOP) 13 HOUSING ABATEMENT ❑ SOLID WASTE VEHICFACILLE <br /> E <br /> TY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ F000 FACILITY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ENT PLANT <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH C3PKG TREATM <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEM TOILET TATTOoiaODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> [IMEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1, List up to ten addresses in the space abovs. MUSTe seected fif (209) <br /> elect thpf files from <br /> r a list a38 or by mail checking <br /> the appropriate box(es). At least one file type <br /> o the <br /> address indicated above. <br /> 2. EHD will notify Ins applicant if any EHD files exist. An appointmentdays <br /> for review will be confirmed <br /> he files <br /> approximately five business days but no later than ten(10 da s after receipt of application. <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 far review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not retumed 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 /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PHONE FAX INITIALS <br /> DATE CONFIRMED <br /> REVIEWED YES NO REVIEW DATE <br /> Eno eea:noe <br /> wenooa <br />