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08/26/2003 09:56 2099566989 GRUBB AND ELLIS PAGE 01 <br /> DATE RECEIVED EHD LOG NUMI <br /> SAN JO,AQUIN COUNTY ` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`I Floor Stockton, CA 95205 <br /> NWG'266 468-3420 Fax: (209)464-0138 Web:wyvw,.co.san-joaquin.ca.us/ehd <br /> E6NV1RQIl Tffi pUBX.IC RECORDS RELEASE APPLICATION <br /> APPLICANT: ' ' / �q y"Pw BUSINESS/AGENCY: �AE'N9 A-A"X Gd <br /> ADDRESS: ��`� G'f/ /I/I/.L.G/.f +"Ve PC#, 2- 1S�-jLQ j <br /> PHONE: ox - 4,-z FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE RE=QUEST-$93.00 FEE--RE PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE .► d% <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> v dI/. A �'V S� a 7� rd/i/ ❑ Unit 1 <br /> 3. t -4,8- <br /> CAY ❑ Unit 2 <br /> .. SV" <br /> S. t cityUnit 3 c14,�3 <br /> r. Unit 4 (f <br /> 8 9h.s1 Gty <br /> 9, a nit it <br /> io. Stroet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �NDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ 801_10 WASTE VEHICLE <br /> e7 }UNDERGROUND TANK(MONITORING/REMOVAL) C1 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILIS' <br /> ❑ TArr00/80DY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) — <br /> 1. List up to ten addresses in the apace above. Select the type(s) of files from the list above by checkl <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or[Bell to tt I <br /> ad0["s Indlcalyd 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 file <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 I v <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorganised by EHD staff at the expe > <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to rev v. <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 ' ANiTIAL& <br /> REVIEWED YES NO REVIEW DATE <br /> FHD"-02-000 <br /> Sl3r1001 <br />