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08/03/2007 FRI 11:44 FAX 20" 12999 SJC PUBLIC WORKS f 002/003 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH UEPARTMEN <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> n <br /> (209)4683420 Fax: (209)464-0138'Web:www_co_san joaquin.ea. <br /> 0 <br /> 73*7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT '�laudia 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 /> (Pleas*allow 10 business days from date of application submittal) <br /> CHECK BOX To EXPEDITE REQUEST <br /> �-59/3/.00AFEE—REQUEST PROCESSED IN 3 BUSINESS DAYS p <br /> SIGNATURE OF APPLICANT [��. - Gy�LY DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> gqo E6!nC _Md Wd c [Iunit 1 - <br /> z. scree, 7 <br /> I stee, AJ rjr Unit 2 <br /> 4. Stroll G <br /> 6. Suets G L-fa 1'\ -pr. Unit 3 <br /> 7. s 0 LQ e � _F Unit 4 <br /> 1219 011 p-- Unit 5 <br /> ,o. sinCky <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) d DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH �PKG TREATMENT PLANT (� <br /> EKED PERMITTED FACILITY Cl MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS �—ice---• <br /> TATTOO/BODY PIERCING ❑ POOL/SPA in LAND USE APPLICATION SnES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) /�2 <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking'v <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mall 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 /> S. *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 /> �G1+EF(RNEEQihl - <br /> J�ATE IG�ft>1Fll�dhED .' ,. .- P1i�I1!I1= �ECI'IX� <br /> DlBIYOW <br />