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FROM ENGEO INC TRACY, CA — FAX NO. : 209-835-0675 --Dec. 10 2004 03:18PM P1 <br /> DATE RC=CaIVtU u w <br /> C E C 1 0 2004 � <br /> SAN COUNTY . <br /> ,NVIRONMENTAX,HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (20,9):468-3420 Fax: (209) 464-0138 Web: www•.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. CASEY I-CA)m) BUSINESS/AGENCY: CN 6 EO <br /> ADDRESS: 2B�D /(�• �iP14L°Y ALU • f 37K <br /> PHONE:_ o?- S36'66/0 FACSIMILE: 2e>j- !S 315 - 6 67 [[�� <br /> TENTATIVE'APPOINTMENT DATE: A S R Time: <br /> (Please allow 10 business days from date of application submittal) <br /> rl CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /tom. DATE &1,16 d y <br /> Decartrnent Use Only <br /> FILE ADDRESS UNIT <br /> A) ON 1,14 Unit"it <br /> 2. S.(_-et �-' <br /> 4. Stfetl�7 ,- <br /> s. s,-.t O Unit 3 <br /> 6. S:cet 0 G <br /> �. st'eet c Unit 4 <br /> ' —V 8. Slrpet 3110 Oty <br /> 330 c Unit 5 <br /> r, <br /> ,0. Street c' <br /> ty <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES , \p / <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING A13ATVMENT � OLID WASTE FACILITY <br /> A <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY //�aRY WASTE VEHICLE X <br /> UNDERGROUND TANK(MONITORING/REMOVAL) �OG KENNEL <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH KG TREATMENT PLANT \( <br /> TIERED PERMITTED FACILITY �}14TEUHOTELUMPERTRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING POOLISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILnY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking f `\ <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the \n <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 fifes <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 /> 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 48-02-0GG _ <br /> N&2003 <br />