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08/02/2007 THU 16:51 Fel 209- )99 SJC PUBLIC WORKS 2005/005 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMFN <br /> 304 E Weber Ave 3"'1 Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san joaquin_ca. i <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT: Claudia Gemberling BUSINESS/AGENCY: San Joaquin County Public Works Department <br /> ADDRESS: 1810 E. Hazelton Avenue, Stockton, California 95205 <br /> PHONE: 953-7624 FACSIMILE: 468-2999 <br /> TENTATIVE*APPOINTMENT DATE, Time: <br /> (Pleaso allow 10 business days from dato of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 <br /> FEE-REQUEST,aI �PR�OCfESSED IN 3 BUSINESS DAYS t� � <br /> SIGNATURE OF APPLICANT DATE <br /> y DATE <br /> Department Use Only <br /> FILEAD0RCSS UNIT <br /> � ❑ Unit 1 <br /> Z. 5yreet G <br /> 5. Slmel G r F Unit 2 <br /> G. Sbal 02k oftyF F 1 <br /> "3O, Unit 3 " <br /> e. sneer / Gt %sy\ /U • F \ <br /> _f�ln (1 �Q_ <br /> Unit 4 1 <br /> c <br /> 9. Ste& 0 Ll dLLGC,_ lbY'Ik Cfty - l' ❑ Unit 5 <br /> III- swat 110 8 D UX-40L �I(l VC city {��^�T- F <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENTSOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Q DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTF-UHOTEL Cl PUMPER TRUCK/YARDICHEM TOILETS <br /> C7 TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 1209)464-0138,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 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 /> �0!NO(fiMED a l bi 11 -�iA i' <br /> D TE OOl+1IRMeD .:_ ` (CIv �Nt7'I� <br /> ..7 - <br /> �#1=Sf.�ElffCl=1:5,; - :. �'�.:.`�•.;�:.�'� :-tr� . , <br /> EHD 4M-M <br /> 8!ElR009 <br />