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F_ N : Geo -Phase Environmental FAX NO. : 2095690295 _ lar. 14 2005 11:19RM P2 <br />DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />]ENVIRONMENTAL fi HEALTH DEPARTMENT 0(0 <br />304 E Weber Ave 3rd Floor Stockton, CA 95205 (��} <br />(209) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca.JM4H A it; QtIl0: 08 <br />PUBLIC RECORDS RELEASE APPLICATIOS,E.PaviR uUOtv lf' cov>`dry <br />APPLICANT: S (!fie CZ BUSINESS/AGENCY:�ITEP <br />�y <br />ADDRESS: <br />PHONE: ajZ ! 3 FACSIMILE:_ 5' <br />TENTATIVE" APPOINTMENT DATE: �iJr/ j Tlmo: <br />(Please allow 10 busin©ss days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT _ DATE _ <br />--_I 1_C,) <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />'74 <br />')apartment Use Only <br />UNIT <br />FILE ADDRESS L@tR�ih� Y rlt <br />Unit 1 <br />r <br />ply <br />�. <br />3;reet <br />G <br />3, <br />Streot <br />/ <br />4. <br />Street <br />G' <br />5. <br />s+rect <br />Q <br />6. <br />StreN. <br />7. <br />Sreet <br />City U <br />9. <br />S;rrcl <br />G <br />10. <br />5veec <br />G <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />'74 <br />')apartment Use Only <br />UNIT <br />❑ <br />Unit 1 <br />❑ <br />Unit 2 <br />p� <br />Unit 3 <br />/ <br />Unit 4 <br />❑ <br />Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY <br />OTHER CLEANUP SITF (NON -LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) O DOG KENNEL 0 DAIRY <br />HAZARDOUS WASTE GE=NERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT <br />Q TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOOIBODY PIERCING M POOLISPA In 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 (209) 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 availabl,- <br />4. Any file not returned in the same Condition as released will be reorganized by END staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prier t0 review. <br />5. 'TENTATIVE appointment dates must bo 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 CONFIRMI*D PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />EHp 48-02-008 <br />8!812007 <br />