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Geo-Phase Envirormental, FAX ND.- 2095690295 �•l�Tul. 26 2004 04:34PM p2 <br /> DATE RECEIVED / EHD LOG NUMBER <br /> SAN JpAQUIN COUNTY <br /> RECE91WEID ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Moor Stockton, CA 95205 <br /> JUL 2 g 200 )468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.us/ehd <br /> ENVIRONMENT PUBLIC RECORDS RELEASE APPLICATION <br /> P V <br /> APPLICANT: <br /> ADDRESS: '927— ek w 4g2n o r/ <br /> lve- <br /> PHONE: �_ �'.� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: ^&Z ZU_rime: 44 <br /> (Please allow 10 busineas days from date of application submitt q <br /> bIECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINES PAYS <br /> SIGNATURE OF APPLICANT DATE raocr <br /> Depadnent Use Only <br /> FILE ADDRESS UNIT <br /> tMM03 OW 5-25 To <br /> L I0 ❑ Unit 1 <br /> s. M303 rr i-e G"^' ctr2L ❑ Unit 2c�y <br /> 1. 3VOM CW/ <br /> L skW ft <br /> l <br /> 6y. <br /> aeed Ck <br /> go" CRV <br /> s• ftd ft 1 0 Unit 6 <br /> Io. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) o HOUSING ABATEMENT Cl SOLID W ACILOY <br /> 4 OTHER CLEANUP SITE(NON-LOP) o FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) o DOG KENNEL o DAIRY <br /> HAZARDOUS WASTE GENERATOR o CHICKEN RANCH E3 PKG TREATMENT PLANT <br /> a TIERED PERMITTED FACIL M 13 MOTEUHOWL, o PUMPER TitUCK/YARD/CHEM TOILETS <br /> O TATTOOIBODY PILSRCWG o POOUSPA 13 LAND USE APPLICAZON SITES <br /> O MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types)of flies from the list aboye by checking <br /> the appropriate box(es). At least one flie type MUST be selected. Eax to(209)464-0138 or mail to the <br /> adgress indicat¢1 <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 /> s. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after-3:00 pm will be processed the next business day. Lj <br /> CONFIRMED APitOINTMI:NT.•DATE 7111A�, <br /> DATE CONFIRMED PHQNE • FAX INITIALS' <br /> REVIEWED YES -NO REVIEW DATE <br /> sit"" <br />