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FROM Geo -Phase Environmental C. FAX NO. : 2095690295 Jun. E9 2006 03:231`11 P2 <br />1_HD LOC- NUMBER <br />DATE RECEIVED SAN JOAQUIN CoTJN'CY <br />RC 1!�[11�L�� ERO?dMENTAI.HEAT�THi�EPART1vIENT I <br />304 F Weber Ave 3`d Floor Stockton, CA 95205 <br />JUN 9 Lflod209) 468-3420 Fzx- (2.09) 464-0138 Web- www.00-6'an-joaquin.ca-lis/ehd <br />ENVIBONMEN i HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />P�-�t►ci' �- - -- <br />'4rAr RU51NcSS/AGENCY: <br />APFi_ICANT: ,_5L zl <br />ADDRESS: _ }..�� / e °•HCr� <br />PHONE: �_ <br />FACSIMILE' 'o4/ <br />TENTATIVE� APF^OINTMENT DATE:' <br />� Time: J__.._..— <br />(Pt^ase allow 10 business duys from date of application submltta') <br />L15CH,ECK BOX T(+ W- ET)n REQUEST. $f!3.00 FEE - REQUEST PROCESSED IN 3 SL�fiINESAYs <br />S p <br />AT E <br />SIGNATURE OF APPLICANT , �_�� Ce artrnent Uza OdY <br />fj Un t 1 <br />13 Unit 2 k I <br />Unit 3 <br />1 l <br />j� unit 4 <br />❑ urlt 5 <br />0 HOUSING A13ATEMV NT [i SOLID 1't'ASTE FACUTY <br />l'r UNDERGROIiNU TANK (UST) CLEANYIP SITE (LOP) p FOOD FACILITY ❑ SOLID SVA ;TE VEHICLE <br />,",OTHER CLEANUF SITE (NON -LOP) D DOG KENNEL Q DAIRY <br />,0 UNCERGROUND TANK (MOPIITOF.INGIREIAOVAL) 1-7 CHICKEN RANCH ❑ PKr. TREATMI:N'T PLANT <br />❑ HAZARDOUS WASTE GENERATOR 0 IAOTELIHOTEL t0 PUMPER TRUCIt1YAnDICHEIY TOILETS <br />0 TIERED PERMnTED FACILFTY ❑ POOLlSPA ❑ I14flD USE APPLICATION SITES <br />Cl TATTOOIBODY PIERC114G ❑ OTHER (Fl. -EASE SPECIFY)---------- <br />El <br />PECIFY) -- -- -El MEDICAL WASTE FACILITY <br />1 Lint up to ten addre�.,es'sn the space above. Select <br />the e acted f Flax t es rorr 248H 464-J1—, 8 Org <br />the appropriate box(es). At least one file typeMUSTbe <br />address indicated above. 8 -It if any <br />2, F_HD will notify buPlne_ss days but fnoFlatEles rtha;l (9) daxist. An ys fteent orEeeilpt of application. fT9�a fiiE's <br />approximately <br />will be held for a maxlmum of five business days for review. Appointments should be s.chc`dale'c <br />accordingly. <br />3. Afiie tilat is actively being worked on by EHQ staff may not be immediately available for review.A r;em' <br />tippli-�ztion ma}� be submitted When tho file is available. , esY <br />q.. Any file not returned in the same condition a -s released will b$ reorganized bEif>? staff a rior to evievr, <br />of thFj applicant. Ftltur a file reviews by the same applicant may require a $9Z.00 dep� p <br />(;. ''T1=NTATIVE appointment dates must be confirmed with EHD staff. <br />after 3:00 prrl will be processed the next buy <br />sineas da <br />6, Nplications receivedTIME <br />^� <br />GONRRME-i) AnPOIN17MENT va7 <br />UAi'E c(JEVF1Ridi1=9� <br />P1l4NE'.. FAX INi1 IE <br />Ri~VIMyED ES 11G REVIEW HATE. --- <br />,cW.a0a <br />