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Tuesday, November 04, 2003 8:53 AM p.02 <br /> DATE RECEIVED U <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton;CA 95205 <br /> r (209)468-3"420 Fag: (209)464-0138 Web-. www.co.san-joaquin-ca.us/chd <br /> PUBLIC RECORDS RELEASE APPLICATION z <br /> APPIItANr: Brad Johnson BUSINESSIAGENCY: ACQUIRE <br /> ADDR>ss: 410 West Deerwood Lane, Tracy, CA <br /> PHONE: (.209) 835-2575 FACSIMILE: (209) 836-2713 <br /> TENTATIVE*APPOINTMENT DATE: TWne: <br /> . e + <br /> (Please allow 10 business days from date of application submittal) 5 I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQU T PROCESSED IN 3 BUSINESS DAYS <br /> J <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> +' Street 75 W. Val iCo Roadapy Trac <br /> 2. Street ❑ Knit 1 <br /> _ o- <br /> a St a Ci <br /> ty <br /> a: Street c El Unit 2 <br /> s� h <br /> s. street ❑ Unit 3 <br /> City <br /> c' <br /> a stree! ❑ Unit 4 <br /> _ 3 <br /> 9,. street I <br /> c' <br /> 10. street ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 6 <br /> XXUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 17 HAZAkDOUS WASTE GENERATOR 0 CHICKEN RANCH Q PKG TREATMENT PLANT <br /> 12 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING 0 POOLISf A 13 LAND USE APPLICATION SITES 1 <br /> 0 MEDICAL WASTE FACILITY C3 OTHER(PLEASE SPECfFY) - 14 1 <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking �I <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the ` <br /> address indicaked above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed I <br /> approximately five business days but no later than ten(10)days after receipt of application. The files i <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 END staff may not be immediately available for review. A new r 4 <br /> application may be submitted where the file is available. :I, <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense s <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 /> k <br /> CONFIRMED APPOINTMENT DATE TIME 1 <br /> DATE CONFIRMED PHONE FAX INITIALS y <br /> REVIEWED YES NO REVIEW DATE <br /> EH048-02�OS <br /> AlB2003 <br />