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FROM Geo-Phase Env1ror€mentatSWc. FAX NO. . 2MS690295 `✓Jul. 19 2002 04: <br /> SAN JOA U TYPUBLtC HEALTH SERVtCtEveD <br /> TAL HEALTH DIVISION <br /> 3 EBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 JUL 2 2 2002 . <br /> � <br /> PUBLIC RECORDSRELEASEAPPLICATI <br /> IROwVIENt HEALTH <br /> APPLICANTd� �N �"G( MINE SSIAGENCY S'D/ �S G ✓/ �•w�,.T4 <br /> ADDRESS ?33 .i., ✓ , <br /> PHONE_ ®7 �Ov FACSIMILE <br /> TENTATIVE%APPOINTMENT DATE / YTIME <br /> (Picaaa give to 0 business ds ro►n of ap tion submittal) <br /> "XIS <br /> CHECK BOX TO,EXPEDITE REQUEST.Sti7.00 FEE-REQUEST PROCESSED IN USINESS DAYS <br /> sj <br /> SIGNATURE OF APPLICANT DATE �1 TfQ <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PRQGRAM ELEMENTS EARCH <br /> 501* <br /> ' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 17 FOOD FACILITY O SOUO WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) D DOG KENNEL O DAIRY <br /> O HAZARDOUS WAS GENERATOR 17 CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIERED PERMfq FACILITY D MOTEUHOTEt. O PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOIBODY PWRCING O POOL/sPA '~- ' O LAND USE APPLICATION SITES <br /> d MEotCAL wASTd FACILITY o PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List up to ten addresses in the space above. Select the typQ(s)of fittas from the List above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-01 18,ormail t!2 the <br /> Oft,s indicitaq above <br /> 2. END will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ton(10)days after reCaipt of application.-The files <br /> will be held for a maximum of five business days for review. <br /> accordingly. Appointments should be scheduled <br /> 3. A file that is actively being workot on by END staff may not by Immediately available for review. A new <br /> application may be submitted whcn the filo Is available. <br /> 4. Any File not returned In the same condition as released will be reorganized by END staff at the expenze <br /> 5• <br /> Of the applicant. Future file reviews by the Same applicant may require a$87'TENTATIVE appointment dates must be confirmed with END staff. .00 deposit prior to revIaw. <br /> 6. Applications received after 3;00 pm will be processed the next business day. <br /> i <br /> CONFIRM ' <br /> Ep APPOINTMENT DATA <br /> TIME <br /> ! DATE CONFIRMED <br /> PHONE PAX INITIALS <br /> REVIEWED . I. YES REVIEW(yQ REVIEW DATE <br />