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FROM : Geo-Phase Environmental.,c. FAX NO. : 2095690295 Feb. 17 2006 05:38PM P2 <br /> DIITEiR�(;>=LVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENviRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> F Q09140-3420 Fax. (209)464-0138 Web:www.co.san-joaquin,ca.us/ehd <br /> PUBLIC R <br /> ECORDS RELEASE APPLICATION <br /> APPLICANT: 97ff/4? `i 2M <TIl//gyp( BUSINESSIAGENCY: 6Z(W !�4pSP '-ndrrdrn�,CN/ � <br /> ADDRESS: aT 37 PN<iw. d+t A/{ <br /> PHONE: n--'U-� FACSIMILE: <br /> TENTATIVE;APPOINTMENT DATE: � Time: r, ,�_• ' <br /> (Please allow 10 business days from date of appllcation aubmittaii <br /> W6HECK BOX TO EXPEDITE REQUEST.$9933..00 FEE-REQUEST PROCESSED)JK3 BUSINESS PAYS .,8 <br /> SIGNATURE OF APPLICANT ✓ /"' DATE <br /> 17 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t aesel 3 a 3'M ' <br /> ❑ Unit 1 <br /> Unit 4. Seca Q ❑ <br /> s. a� <br /> e. seep Unit 3 <br /> o <br /> r. <br /> ON <br /> Unit 4 <br /> c. seeet .. <br /> e sMAL F 19 <br /> ❑ Unit 5 <br /> AV <br /> 7.r ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �.+ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> .� OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILM ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ 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(as). 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. Afile 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 available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. '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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE. FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> MD/s.ozaoc <br /> ennom <br />