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---r�M Geo-Phase Environmen Inc. FAX NO. : 2095690295 Nov. 12 2003 04:56PM P2 <br /> DATE RECEIVED _ EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> l ENVIRONMENTAL HEALTH DEPARTMENT <br /> N 0 V 1 NQ 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (2.09 468-3420 Fax: (209)464-0138 Web: www.co.san_j"oaquin.ca.us/ehd <br /> FNVIRUNMEN i HEAL1 <br /> PFRMIT,'SERVICFS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �/ d(�i /�a^f y' BU,ISINESSIAGENCY::2:1!a("-1 �'J{t/%��1/�{ +• Ace <br /> ADDRESS: �q3 /P.-►r��-•aii Ads / /GOyt P t <br /> Cr' ?� <br /> PHONE: 7� 0� 3 FACSIMILE:__ 441rz-? <br /> TENTATIVE'APPOINTMENT DATE:�1Le, ��/ S _Time: �! <br /> (Please allow 10 busines3 days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> Y SIGNATURE OF APPLICANT DATE �� 6 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. sire, 3 G 4,1 t ite v' CJi cu <br /> p Unit ' (� -,7 <br /> t. simet m City <br /> "I <br /> 3. Sveet . G ✓ C' � 1, 1 <br /> Unit 2 <br /> ,. Street d z G 1- G O <br /> S. streoi 7 C 4arY+ CI oZ <br /> 6. Street City <br /> 1. street City <br /> Unit <br /> 0. Strom Dty <br /> 9. sleet Oty Unit 5 <br /> 10. soca 2u J <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y !t� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> In TIERED PERMfTTED FACILITY 0 MOTEUHOTEL Q PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOO/BODY PIERCING O POOUSPA Cl 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(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. 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 $93.00 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 /> 0 1E.1 <br /> CONFIRMED APPOINTMENT BATE TIME , <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> eHo+aasaos <br /> a WOO <br />