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FROM Geo -Phase Environmental+ c. FRX NO. : 2095690295 Dec. 24 2002 12:03PM P2 <br />i/�r, iSAN JOAQUIN COUNTYPWBLIC HEALTH SERVICES 1�, <br />I ENVIRONMENTAL HEALTH DIVISION <br />.304 EAST WEBER AVENUE, THIRD FLOOR <br />DEC 2 4 2002 STOCKTON CA 05202 <br />(200) 458-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT .�7%tdZF /,4? -y l7T-17 BUSINESS/AGENCY WT"4Ff_"W,0C •"VyrAny_ "=_ <br />ADDRESS 0.9937 dr�+►�-,oM A �hW'wy1T p _ <br />PHONE 7 `� r •OiZ9a .- ,FACSIMILE 7 of /� <br />TENTATIVE' APPOINTMENT DATE 3//4% TIME 5 <br />(Please give 7 to jo busincalf days from date of application subndUal) ' ' <br />4M CHECK BOX TO,FXPC-DITE REQUEST -$67.00 FEE—REQUEST PROCESSED IN g IAUSINE55 DAYS <br />SIGNATURE OF APPLICANT 'ejjE�-104 DATE y r s <br />r FILE ADDRESS <br />THIS SIDE END STAFr,53 i ONLY' - <br />PROGRAM-LEME-:kS +`LtARZli 1 F ' <br />7 V. Sius�a - r r • C/«will <br />Z, NOERGROUND TANK LUST) CLEANUP SITE (LOP) <br />O HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />:;f OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONrrORINGIREMOVAL) <br />0 DOG KENNEL <br />❑ DAIRY <br />O HAZARDOUS WAS3E GENERATOR <br />30 Al. ! -- S• J'G <br />Lrt <br />u TIERED PERMITT§D FACILITY <br />O MOTEVHOTEL <br />O PUMPER TRUCKIYARDICHEM TOILETS <br />O TATTOOIBOOY P91RCING <br />O POOVSPA -­ <br />O LAND USE APPLICATION SITES <br />LaQ r✓�sr L?M� Lad/ - r./Jd� <br />O PUBLIC WATER SYSTEM <br />13 OTHER (PLEASE SPECIFY ABOVE) <br />i$npgr <br />i <br />t <br />ern <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />Z, NOERGROUND TANK LUST) CLEANUP SITE (LOP) <br />O HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />:;f OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONrrORINGIREMOVAL) <br />0 DOG KENNEL <br />❑ DAIRY <br />O HAZARDOUS WAS3E GENERATOR <br />O CHICKEN RANCH <br />O PKG TREATMENT PLANT <br />u TIERED PERMITT§D FACILITY <br />O MOTEVHOTEL <br />O PUMPER TRUCKIYARDICHEM TOILETS <br />O TATTOOIBOOY P91RCING <br />O POOVSPA -­ <br />O LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY <br />O PUBLIC WATER SYSTEM <br />13 OTHER (PLEASE SPECIFY ABOVE) <br />V <br />�N <br />ttttt� <br />0 <br />0 <br />1. List up to ton addresses in the space above. Select the type(s) of files from the list above by chocking <br />ttie appropriate box(es). At least one file type MUST be selected. Fax to (209) 454-0138 or mall 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 len (10) days after receipt of application. Tile files <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A file 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 $87.00 deposit prior to review. <br />5. '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 />I REVIEWED YES NO REVIEW nATF <br />