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FROM : Ground Zero Analysis PHONE NO. : 209 838 9883 Jun. 28 2005 10:06AN P1 <br /> DATE RECEIVED END LOG NUMBER <br /> SAN JOA(ZUIN COUNTY <br /> ENVIP,0NMENTAL HEALTIi DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co,san-joaquiri.cams/chd 7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:-7 hn T-an BUSINESS/AGENCY: (,,ra nd] 7Prn Ana 1 y a Tnr . <br /> ADDRESS: 1714 Main- Street,, Fac -1013 ,CA 95320 <br /> PHONE_ 1,209) 838-9Q88 FACSIMILE: ( 209) 838-9883 <br /> TENTATIVE"APPOINTMENT DATE:,_ July_ 12, 2 005 Time: <br /> (Please allow 10 buslness days from date of application submittal) <br /> u CHECK BOX TO EXPEDITE REQUEST-$93. F E-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT -- DATE `c <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> srroHi)nter caStockton <br /> z stere+ CAy ❑ Unit 1 <br /> 3. Sheet <br /> �. Sueet cap <br /> ❑ Unit 2 <br /> s st aet city T Unit 3 <br /> Cit <br /> T street CAY <br /> 6' street ci Unlit 4 <br /> 9. Sweet <br /> to s ❑ Unit 5 <br /> c. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> OTHER CLEANUP$ITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL /fit., C3PUMPER TRUCK/YARD/CHEM TOILETS <br /> 173TATTQO/BODY PIERCING POOL/SPA t-t ❑ USF APPLICA'[I�N <br /> Q MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)_UL&( 4 +F- <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 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 faceipt 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. Futuro 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 /> EHD 4"2-006 <br /> Mm <br />