Laserfiche WebLink
FROM Geo-Phase Env i ronmentdr—1 nc. FAX NO. 22195690295 \ <br /> 95690295 1 Jul. 12 2005 11:07AM P2 <br /> ' DATE RECEIVED EHD LOG NUMBER <br /> SAN JCAQ1rIN COUNTY <br /> nECOVED ENVIHONMENTA.HEALTH DEPARTMENT <br /> u 304 E Weber Ave 3 Floor Stockton,CA 95205 <br /> JUL j2G�tt�-3420 Fax: (209)464-01:18 W,!b:www.co.san joaqum.ca.us/ehd <br /> FNVjRGNMENT HEAVUBLIC RECORD 3 RELEASE APPLICATION/^ <br /> APPLICANT 4- 8USIT ESSIA1ENCY: '~!'144'%"z <br /> ADDRESS: ��-ye7__5_Z_ 4le-w °lo-+dyf <br /> PHONE: FACS MILE: ff r, 927r22 5: <br /> TENTATIVE*APPOINTMENT DATE: ,,,C-04�r Time: <br /> (Please allow 10 busing&i days,tom date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FEE-RE PEST PROCESSED INS SU ESS PAYS <br /> SIGNATURE OF APPLICANT✓ �`/ `"mss DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. sveet G4&e_rfr 4Jq 0 A 2p Unit 1 U:S <br /> 2. Street SCJ /ya✓ r/ .2�� <br /> s. st,.t ❑ Unit 2 <br /> 4. $ <br /> t�` 3 <br /> ty <br /> Unit 3 <br /> 6. Street Cttt <br /> h <br /> t. sv66t ot+ •fitUnit 4 e000 <br /> e. sheet <br /> e. Stmt Ada 0 Unit 6 <br /> >=NV1 EALTH DEPARTMENT FILES <br /> �r <br /> UNDERGROUND 4_. ANUP H�)USINCt ABATEMENT ❑ SOLID WASTE FACILITY <br /> WOTEiER CLEANUP SITE 0 OP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> O UNDERGROUND TANK(MO ORING/RE AL) a Dt G KENNEL ❑ DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑ Cl IICKEPI RANCH 0 PKG TREATMENT PLANT <br /> D TIERED.PERMMED FACILITY C] M)TEIJt OTEL ❑ PUMPERTRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING 17 Pt)OLISF A a LAND USE APPLICATION SITES <br /> ❑ MEDICAL,WASTE FACILITY ❑ O'ITER(;LEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. ;'elect the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one fiie 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'lies a Kist. An appointment for review will be confirmed <br /> approximately five business days but nc later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five busin?ss days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on b) EHD staff may not be immediately available for review. A new <br /> application may be submitted when the•Ile 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 t he sane applicant may require a$93.00 deposit prior to review. <br /> s. 'TENTATIVE appointment dates must bE conf rmed with EHD staff. <br /> S. Applications received after 3:00 pm will 3e prucessed the next business day. <br /> CONFIRMED APPOINTMENT DATE - TIME• <br /> DATE CONFIRMED •PI10NE FAX' . INITIALS _ <br /> REVIEWED YES NO• REVIEW DATE <br /> EHO t8-02.006 <br /> AM2009 <br />