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FROM : Geo—Phase Envlronnentalc. FAX NO. : 2095690295 Jul. 19 2002 04: PM <br /> AN,0;soq ? - . . . ­. 1;JOAQU TYPUBLIC HEALTH <br /> 3 TAI_ HEALTH DIVISIONutCtT-u <br /> �L�1J � <br /> �,Q EBER AVENUE,THIRD F=LOOR <br /> STOCKTON CA 95202JUL f <br /> (209) 468-342a '� 2 02 . <br /> _ - PUBLIC RECORDS RELEASE APPLICAYI 1R,0N rur HEALTH <br /> APPLICANT (/� �(Q,y �.•� <br /> p 8U5fNE:5SlAGENCY <br /> ADDRESS 7 ✓ �y �G d <br /> PHONE - FACSIMIL@ <br /> TENTATIVE' APPOINTMENT DATL" TIME <br /> (Please givs to 0 business da ram a of ap 'cation suli�nillal} — .� <br /> A(-CHECK 8OX YO.WED{TE REQUEST- (1 �� . <br /> � 5 .04 FEE REQUl:57 P1iOCt:55�D IN USINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> FILE ADDRESS T14I5 SIDE EHO STAFF USE ONLY <br /> PROGRAM CLEM>-NTS EAftCH . <br /> N .+r <br /> F <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK{UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMLNTOTHER CLEANUP SITE(HON-Lop) O <br /> SOLID <br /> WASTE FACILITY <br /> UNDERGROUND TM13 FOOD FACILITY E3 SOLID WASTE yEH1CLCATORINGfRLMOVAL) D DOG KENNEL a DAIRYO HAZARDOUS WASGENERATOR O CHICKENRANCH O PKG'rREArVEN7 PLANTQ TIERED PERMrFTGD FACILITY O MOTELIHOTGL O TATTOOIBODY P <br /> CMEDICAL YASrd�iRCING n YOOL5PA O PUMPER TRUCK/YARD/C <br /> H <br /> EM T <br /> OAETS <br /> FACILITY O RAND USE APPLICATION SITES <br /> PUBLIC WATCR SYSTEM O OTHER(PLEASE SPECIFY AnDVL•) <br /> I• List up to ton addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(os). At!cast one file type MUST.be selected- Fax to 20� 464-0'138 or Irtail to t1 c <br /> address indicated above. <br /> 2. EHD Will notify the applicant if any EHD files exist. Ah appointment for review will be confirmed <br /> approximately five business days but no later than ten 00) days after receipt of application.•The files <br /> will be held for a maximum of five business days for reviaw. Appointments should be scheduled <br /> accordingly, <br /> 3• A file that is actively being worked an by EHD Staff may not bC immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4• Any fife not returnad in the same condition as releatsed will 120 reorganrted by END�tafr at the expense <br /> of the applicant. Future file rcvlews by the same a0licant may require a $87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 0• Applications received after 3;00 pm will be processed tho next business day. <br /> ! <br /> CONFIRMED APPOINTMENT DATE ' <br /> DATIr CONFIRMEI) TIM E <br /> PHONE FAX INITIALS <br /> REVIEWED YES . <br /> rH oo �e •aero�roe NO REVIEW DATE <br />