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FROM Geo—Phase Environmental FAX N0. 2D95690295ay. "1123PM P2 <br />SAID JOAQUIN COUNTYPUt LIC <br />HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />" 304 EAST WEBER AVENUE, THIRD FLOOFZ <br />STOCKTON CA 95,ZO2 / /MAY 2 8 2002 <br />(209) 468-3420 S <br />_ PUBLIC RECORDS RELEASE APPLICATION ENVIRUNMENT HEALTH <br />,+� PFRMj.jZSERVIGEL- <br />APPLICANT /7"48' 04-9.. 44,-t ElU5JNES5iAGENCY p �QJ <br />ADDRESS <br />PHONE FACSIMILE QZ J�j <br />TENTATIVE" APPojN7MCNT QATE 7 TIME <br />-sL <br />(Plcosc Oivr l0 4 uSinC)s,1*R0GAAN#3?USlNCSS <br />to tI + 4f application ;ubmitlal) <br />CHECK BOX TO,E.XPEDrrE REQUE5T • 547.00 DAYS <br />SIGNATURE OF APPLICANT PATE <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDCRG ROUNDTANK(VST) CLEANUP SITE= CLOP) 01 HOUSING A3ATEMENT O SOLID WA5TE FACILITY <br />OTHER CLEANUP SITE. (NON -LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) O DOG KENNEL 0 DAIRY <br />HAZARDOUS WAS l G5NF-RATRR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />T3EREC) Pt RMITTED FACILITY 11 PAOTI L)HOTEL O PUMPER TRUCKrYARDICHEMTOiLETs <br />C7 <br />TATTOO/1300Y F91RCING ❑ POOLISPA -1 a LAND USE APP[.ICATION Slit=S <br />C3 ML:DICAL WAST( FACILITY O PUBLIC WATER SYSTEM O OTHER tPLr•.A5E SPECIFY AIJOVE) <br />1. List up to ton addre55Gs in the space above. Select the typQ(s) Of files from the list above by checkinU <br />r ttic appropriate.box(u5)- At least one file type MU5T be selected. Fax to 2.09 4154-0138 or mail In the <br />address indicated above. ;\ <br />2. EHL) will notify the applicant if any EHO files exist. An appointment forXeview will be confirmed <br />approximately five business days but no later than ton (10) days after re ipt Of application. -The fiics <br />will be held for a maximum of fiver business days for review. Appointment should be schoduled <br />accordingly. <br />3• A file that is activoly being worked on by EHD staff may not be imrnecliatcly available for review. Anew <br />application may be submitted when the file h available, <br />4. Any file not returnee! In the same condition as rcfeased will 1)e reorganized by EHD staff at the expcnsc <br />Of the applicant. Future file reviews by the same afiplieant )nay require a $87.00 deposit prior to review. <br />5 `TENTATIVE appointment dates must be confirmed with EHD staff. <br />b. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />TIME <br />DATE C0NPIRMyIE0 PHONE FAX <br />IAN1rlALs <br />REVIEWED '� YESNO <br />REVIEW riATi~ <br />