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08/26/2003 09:56 2099566`RP,� GRUBB AND ELLIS PAGE 01 <br /> EHD LOG NOMi <br /> PATE RECEIVD <br /> �"'' SAN JO,AQUIN COUNTY <br /> �M-4— ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> AAUG"266 *468-3420 Fax: (209)464-0138 Web:www�co.san-joaquin.ca us/ehd <br /> EMVIRID T PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT: ' O�q VAe BUSINESS/AOENCY: Ar f GD <br /> ADDRESS: AP-3 ,.G�c%� pGt' 2, �T .0 T�/J� ,S7- J2 <br /> PHONE: d�- 4c,-7� 3 a� _FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Timer. <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REgUM PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNiT <br /> 57— a 7"r T diV El Unit 1 <br /> 2. 8hN CRYM <br /> 3, a p Unit 2 <br /> 4. she« <br /> s. 9Pr , cityUnit 3 <br /> a. sh..t City <br /> G Unit 4 <br /> a <br /> ty <br /> s C111 nit 6 <br /> 10. sued <br /> ZJACLEANUPr-I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) C3HOUSING ABATEMENT ❑ SOLID WASTE FACILITY THER SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> eTANK(MONITORING/REMOVAL) d DOG KENNEL ❑ DAIRY <br /> gr HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCK/YARDiCHEM TOILE' <br /> O POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICALTATTOOIWASODY PIERCING ❑ OTHER PLEASE SPECIFY) <br /> Q MEDICAL WASTE FACILITY ( ' <br /> 1. List up to ten addresses in the space 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(209 -64-0138 Qmall to tt I <br /> add[2ss Indicoled above, <br /> 2. END will notify the applicant If any END 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 fil, <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 END 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 END staff at the expo >' <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 END 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 INITIAL&= <br /> REVIEWED YES NO REVIEW DATE <br /> EFID 4i-02-001 <br /> Blbf200� <br />