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FRCP' : Geo -Phase Fnvironmental Inc. FAX NO. : 209SG90295 <br />Mar. 21 2000 01:26PIl P2 <br />SAN J.,QUIN COUNTYPUBLIC HEALTH S..oVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(p2yare% f1 O 304 EAST WEBER AVENUE, THIRD FLOOR <br />U ✓ STOCKTON CA 55202 <br />(209) 4683420 <br />-- PUBLIC RECORDS RELEASE APPLICATION <br />LPD LOU 1JUM0E8 <br />- 0��' <br />(j0 <br />C <br />C; <br />APPLICANT S%C.UPr lAnLr BUSINESSIAGENCY <br />a0ORE5S �Z�3 7 (��[•rr C �4 r �_ � <br />PHONE Ag -V-9, Op1f .%z FACSIMILE_/��� dyZ� <br />TENTATIVE" APPOINTMENT DATE rr/ �`� TIME <br />(Please give 7 to 10 business days trom date o1 appllealion submittal) (/ <br />kY CHECK BOX TO EXPEDITE REQUEST - $78.00 FEE -REQUEST PROCESSED IN 33BBUSINESS DAYS I MAR 9 a ?o� <br />SIGNATURE OF APPLICANT gc —.� DATE �6 <br />ENVIRONMENTAL HEALTH DIVISION FILES�� <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />►=WPM <br />❑ FOOD FACILITY <br />❑ SOUO WASTE VEHICLE <br />UNDERGROUND TANK(MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />nn►a611 li <br />O TIERED PERMITTED FACILITY <br />❑ MOTEL/HOTEL <br />❑ PUMPER TRUCK/YARbICHEM TOILETS <br />O TATfOOMODY PEIRCING <br />❑ POOLISPA <br />❑ LAND USE APPLICATION SITES <br />Cl MEDICALWAsTEFACILrrY <br />❑ PUBLIC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />ENVIRONMENTAL HEALTH DIVISION FILES�� <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOUO WASTE VEHICLE <br />UNDERGROUND TANK(MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENYPLANT <br />O TIERED PERMITTED FACILITY <br />❑ MOTEL/HOTEL <br />❑ PUMPER TRUCK/YARbICHEM TOILETS <br />O TATfOOMODY PEIRCING <br />❑ POOLISPA <br />❑ LAND USE APPLICATION SITES <br />Cl MEDICALWAsTEFACILrrY <br />❑ PUBLIC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <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. EHn 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. A file that is actively being wor4ad 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 fife reviews by the same applicant may require a $78.00 deposit prior to review. <br />5. <br />*TENTATIVE appointment dates must be confirmed with END staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />, <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />�11 Ow5100 <br />3 2000 <br />