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FROM_ Geo-Pl,ase Environmental .. FAX NO. : 2095690295 un. C9 2006 03:23PI`1 P2 <br />FHD LOG NUMSE�l <br />QE RI=CEIVED SAN JOAQUIN COUNTY <br />"FC"((�� <br />l� v L� D E 0NMENTAL HEALTH DEPARTMENT' an304 F Weber Ave 3`d Floor Stockton, CA 95205 <br />JUi11 9 Z00�209) 468-3420 Fix- (ZA9) 464-0138 Web: www.00-san-joaquin.ca-us/ehd4 <br />ENVIRUNME,' i HEALTH <br />r aUS1NESSlAGENGY: — <br />AF'FLICANT: 517Y309 la I <br />EMDRESS: C"�_I'Camk � /`'�A fl /�• <br />_fes-�+� <br />PFiON>w: min FACSIMILE: � --�- <br />TENTATIVE* AFFO1N7iali=NT DATE: d , Timet <br />(Please allow 10 business days from date of application submittal) <br />pUBLIC RECORDS RELEASE APPLICATION <br />C5 CHECK 13OX TO F.XPEDTM REQUEST - $0.00 FEE - REQUEST PROCESSED IN 3 B (NESS DAYS s ' <br />DATE <br />OF ,!' ��- <br />SIGNATURE F gl�PLIANT D artment Use Only <br />UNIT <br />n Un't 1 <br />[] Unit 2 <br />/00'Unit 3 <br />Unit 4 <br />[] UrA 5 <br />M, <br />O HOUSING ABATEMENT ❑ SOLID YXAVrE FACILITY <br />e UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 FOOD FACILITY 0 SOLID WANE VEHICLE <br />,R''OTHER CLE<1NtIF SITE (NON -LOP) O DOG KENNEL CI DAIRY <br />UNCERGROUND TANK (MOT4iTOP.1NGlREidOVAL) C3 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />[I HAZ.4RDOU£+WASTE GENERATOR CJ MOTELlHOTEL 0 PUMPER TRUrKryARDicHEK TO3LET-a <br />0 TiERED PERMi1lTED FAC1L" ❑ POOUSPA ❑ LAND USE APPLICATION Sil'CS <br />0 TATTOOIBODy PIERCING ❑ OTHER (PLEASE SPECIFY) <br />Q ryiinDiCAL WASTE i=AGILITY <br />1 Lint Up to ten addresSeS In the space above. Select the type(s) of files from the list above iry checM:i>>g <br />the appropriate box(es). At least one file type MUST be selected. Fax to 299 464-0138 or mail to t:i! <br />address indicated above. <br />2, EFED wlU notify the applicant if any EEiE] files exist. An appointment for review will be confirmed <br />approximately VIII notify <br />five buslrle: s days but no later than ten (10) days after re,eipt of application. The files <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />ac(zordingly. EHD staff may not be immediately available for review. A Uew <br />3. A file that is actively being worked on by Y <br />en the file is available. <br />ap21i,R-ttion may be submitted wh <br />q., Any fila not returned in thf. sante condition as releas; int mabe y rer u4re a $93.QOldep� it prior review . <br />of the applicant. Future file reviews t the same applicant Y a <br />5. *TI=NTATIVE appointment dates must be confirmed with EH17 staff. <br />6. Applications received after 3.00 prn will be processed the next bUSines:s day. <br />CONFIRM d) ApF OiNTiyyfENT , DATE: '. _ , iNiTiF►1 <br />TIME .. � ..... <br />ATE C;ONFIRii IE17 <br />F?1QC�Clr FAX... <br />L <br />REVIEW DATE <br />REVIEWED xis NO ---- <br />:=0Qa <br />