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FROM Geo-Phase EnvironmentaC. FAX N0. : 2095690295 Sun. 24 2004 04:14PM P2 EHD LOG NUMBER q�7 ECEIgE°' SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT JUN 2 4 2004 304 F Weber Ave 3`d Floor Stockton,CA 95205 209)468-3420 Fax: (209)464-0138 web:www.co.san-joaquin-ca-uslehd ENVIRONIN1EW i LAL H PERMMSERVICES PUBLIC RECORDS RELEASE APPLICATION . APPLICANT::022M �a'7 V14BU�SIN•ESSIAGENCY: Gwy7A,9, 'e J� ADDRESS: �q// "fGdV d /k a M /ter" PHONE: —FACSIMILE: S6� &5%2975� TENTATIVE APPOINTMENT DATE: G O Time: (Please allow 10 business days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED I BUSINESS DAYS SIGNATURE OF APPLICANT c.' DATE Department Use Only ,. saeec FILE ADDRESS G + ❑UNIT wac Un it 1 Av af oc- 0y, G G e. sveet w G 4'O Unit 2 ( s svee 00 2 1 S U 1/0 Unit 3 6. Street r u nit 4 q G t) City 0. C7 Unit 5 to, of M c /y 200 a rP Y r 0 . y ENVIRONMENTAL HEALTH DEPARTMENT FILES g UNDERGROUND TANK(UST)CLEANUP SITZ=(LOP) ❑ HOUSING ABATEMENT SOLID WAS F Ch,.ITY "F ❑ FOOD FACIUTv EI SOLID WASTE"V�f;16E� THER CLEANUP SITE(NON-LOP) ❑ DAIRY UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ir HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH EIPKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPERUSE RUCKICATION SIM TOILETS ❑ TATTOOIBODY PIERCING ❑ POOUSPA I:] LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. S. "TENTATIVE appointment dates must be confirmed with EHD staff. gg. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX, INITIALS REVIEWED YES NO REVIEW DATE wazooa�oz-0us i, U: