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FROM : Ground Zero Analysis PHONE NO. : 209 838 9883 Nov. 02 2005 11:41AM P1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> l�= SAN JOAQUIN COUNTY <br /> rL1=` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d floor Stockton, CA 95205 <br /> t�U�J (209)468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.us/ehd <br /> LIT <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APP.UCANT: EIUSINESSIAGENC <br /> ADDRESS: 14 nlof � <br /> (� ` <br /> PHONEt�! J 23� jag FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE: Time: , OO Q '✓Y> _ <br /> (Piaasa allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$9 00 F - EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Departrneni se Only <br /> FILE ADDRESS UNIT <br /> t. r Cw b G Q na ❑ Unit 1 <br /> 2 sv"t C1-y C1-y (�1 <br /> ❑ Unit 24- Stre-e City <br /> t v/ <br /> J <br /> S. sheat CayUnit <br /> 6, 6treat C <br /> OOA <br /> 7. Shoot <br /> CAY <br /> A Sheat <br /> 9 sty ❑ Unit 5 <br /> 10. Street Cay <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) CJ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELMOTEL 17 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑ POOL/SPA 17 LAND USE APPLICATION SITES <br /> MEDICAL WA$7E KACILETY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464013$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 game 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 /> R E-M EWE YES NO REVIEW DATE <br /> ertD�s oaaos <br /> moos <br />