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RON : Geo-Phase Environmenta C. FnX NO. 2095690295 • Dec. 07 2004 12:3310N P2 <br /> EHD LOG NUMBER <br /> DATE_RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTa DEPARTME,NT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> DEC 7 468-3420 Fax: (209)464-0138 Web.www.co.san-joaquin.Ca.us/ehd <br /> HEALTH <br /> PUBLIC RECORDS RELEASE APPLICA'I' ON <br /> APPLICANT: rC/ BUSINESSIAGENCY, (:Qr Ad-re /f� 'it&& -Uwe <br /> Tim <br /> ADDRESSR? Z / X 9 fT 1 A e dttg �t� <br /> PHONE: /11r" X02_3 FACSIMILE: <br /> -f ENTATIVE*APPOINTMENT DATE: <br /> qq J <br /> (Please allow 10 business days from date of application nwmitX l)� f ' <br /> CHECK BOX TO EXPEDITE REQUEST-$83.00 FEE--REQUEST PROCESSED IN 3 BUSINESS DAYS / ? <br /> SIGNATURE OF APPLICANT -_, DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> ❑ Unit 1 <br /> 2, s reel <br /> Qiy ) <br /> 3. Street Ct El, � <br /> 4, Street CAN <br /> ` t <br /> 5. Street G Unit 3 <br /> 6. stroet _ <br /> �. sveet xcity nit 4 <br /> 9. Street `"' <br /> aty Unit 5 <br /> t0- street sx>$.`:Y _ w <br /> Ory <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E7 HOUSING ABATEMENT ❑ SOLID WASTE ACI01TY- -- `J <br /> El OTHER CLEANUP SITE(NON-LOP) <br /> EI FOOD FACILITY 11 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL M DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL 13 PUMPER TRUCIUYARD/CHEM TOILETS <br /> C1 TATTOO/BODY PIERCING 0 POOUSPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDi:.AL WASTE FACILITY C7 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. Afile that Is activ;ly 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 EMD 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 /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Appticatioos received after 3:00 pm will be processed the next business day. <br /> ,01"1 _JRj ED APOOiNT;E?i Ti DATE ... TINIFF . <br /> [TATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE .� l <br /> EMD 48-02.006 . <br /> 8!BlZOOJ <br /> s <br />