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FROM : Ground Zero Analysis PHONE NO. : 209 838 9883 Dec. 19 2005 09:16AM P1 �} <br /> DATE RECE 1 EHD LOC NUMBER <br /> �o \��Jjj 1r�D SAN JOAQUIN COUNTY <br /> ,� ENVIR.ONMENTAL HEALTH DEPARTMENT <br /> p�C 2005 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> (209 411 -3420 Fax: (209)464-0138 Web:www.co.san joaquimca.us/ehd <br /> 2e15 <br /> ENVIRONM�N CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY. <br /> (jly <br /> ADDRESS: / QQ Q <br /> PHONE. p fJi FACSIMI U <br /> TENTATIVE*APPOINTMENT DATE: _Time: <br /> (Please allow 10 b ess days from dat®of application submittal) <br /> CHECK BOX T4 EXPEDITE REQUEST-Sn0a FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department use only <br /> FILE AD RESS UNIT <br /> s. seeet 0 Unit 1 <br /> I sho <br /> cral <br /> s. sceet <br /> &. street „ (! <br /> 6 s4ectCAV <br /> r. s me: c UnR 4 <br /> a sic <br /> a. swat C] Unit 5 <br /> M. Sheet <br /> . City <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 14 UNDERGROUND TANK(UST)CLEANUP$1TE(LOP) 0 HOUSING ABATEMENT 6 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) © FOOD FACIt_IrY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG-KBMEL 0 DAIRY <br /> 13 HA&Avous WASTE GENERATOR O CHICKEN RANCH C1 PKG TREATMENT PLANT <br /> CI.*tIiRED'.pERMt7`W FACILITY Q MOTaMOTEL G PUMPER TRUCK/YARD/CHEM TOILETS <br /> E3 TA17001500Y PIERC114G 17 POOLISPA a LAND USE APPLICATION'S1TES <br /> t7.MIiDloAtt WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to X209)464-0138 of mol to th® <br /> address€nd€crated 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 /> 6. *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 71ME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REMEWED yES NO REVIEW DA'T'E <br /> alto�z.aae <br /> ' tFt�004 ' <br />