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11/17/2003 16:16 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> T ECEIVE_0-_. <br /> ❑ ((�i ) �`/! SANJOAQUINCOUNTY <br /> D ENVIRONMENTAL HEALTH DEPARTMENT <br /> N 0 U 1 7 2 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> )468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/elid <br /> ENVIRONMENT HEALTH <br /> ICE4111 PUBLIC RECORDS RELEASE APPLICATION fff <br /> RF t,AIT (`F� -- <br /> APPLICANT; Didrik Johnck BUSINESSIAGENCY: Geologica <br /> LAADDREss: 594 Howard Street, Suite 400 <br /> HONE: 415-297-7903 FACSIMILE; 772-402-4834 ' ��- <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> rpt"/' (Please allow 10 business days from date of application submittal) <br /> 0+ CHECK BOX TO EXPEDITE REQUEST 00;F -REQUEST PROCESSED IN 3 BUSINESS DAYS 11/17103 <br /> -*SIGNATURE OF APPLICANT 2" Q^-' DATE <br /> - OepartmMtUse Only <br /> FILE ADDR`�S UNIT <br /> 1. s..e 800 Mellow qntenn "• G ❑ Unit1 <br /> n <br /> 757 Moffat Blvd.- ar ❑ Untt 2 <br /> ,,,4btD Moffat Blvd. a ~ <br /> 3 Sh t G <br /> 6. SInK <br /> oat Blvd., Mant G. V <br /> *unit 4 <br /> 0. SV et G' <br /> 9. S:rM� GI u ❑ Unit 5 <br /> 10. SIAM G rM1^ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> "UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON <br /> ❑ F000 FACILITY ❑ SOCIO WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) E3DOG KENNEL ❑ DAIRY <br /> (:I HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY C3MOTEUHOTEL ❑ PUMPER TRUCIWAROICHEM TOILET <br /> ❑ TATTOOIBOOY PIERCING [3POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY <br /> OTHER(PLEASE SPECIFY) <br /> 1, List up to ten addresses in the space above. Select the types) 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 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 EHO 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 /> S. `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 /> Eno Ie-03•MO <br /> ,IV2003 <br />