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DATE RECEIVED 0 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY M <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Frani( Goldman BUSINESSIAGENCY: GeoSoly. LLC <br /> ADDRESS: P.O. BOX 1193 CITY/STATE/ZIP: Meadow Vista, CA 95722 <br /> PHONE(1): 530 906 9048 PHONE (2): EMAIL: .frank goldman@ymail.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT7� tSQCQIm O DATE 05/22/14 <br /> Electronic Inforination: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 12.-1 <br /> 999Tracy Blvd. NPP Tracy503 Larch Road -areed�� Tracy ❑Unit 2tle2 <br /> 3. 16850 Tracy Blvd. NFA Tracy <br /> 4• 425 Larch Road (C9, i Tracy S ❑Unit 3 <br /> 5. 4131 Industrial Waycp_ Tracy <br /> 6 3788 — Tracy Blvd N Tracy _ ❑Upit4- <br /> v. 3940 Tracy Blvd. N Tracy <br /> 8. 3775 Tracy Blvd. N -P Tracy ❑Units <br /> 9. 4110 Industrial Wa GT) Trac <br /> 10. ❑Unit s <br /> Specific Date Range of Information Requested: From 1983 to Present <br /> p� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> id UNDERGROUND TANK(UST)CLEANUP SITE(LOP) p MEDICAL WASTE FACILITY ❑SOLID WASTE FACILI YIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future rile reviews by the same applicant may require a$125 deposit prior to review. —BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHe 48-06 4128114 <br />