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FROM : Geo-Phase Environment` Inc. FAX NO. 2095690295 Jana 13 2004 10:24AM P2 <br /> DATE RECEIVED `..� EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> I,i,F-0 C�I� 1EIQ ENVIRONMENTAL.HEALTH DEPARTMENT <br /> 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> JAN 13 % (I 9) 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:S_7�r�PI4. 4 10-- BUSSINESSIAGENC}Yy.�eCO'/ y�S� !?bd-►��r •►���r1__ <br /> ADDRESS:,�_Z_?, +rP-.�+QM 4e /(D0f�J�d <br /> PHONE: 19"6' d2 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: fse, %/a Time: <br /> (Please allow 10 business days from date of application submittal) <br /> M-tHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE d <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> sre« d0 C cl ~ ❑ Unit 1 <br /> Z. StrecH !/ G �'�✓v' <br /> 3. Street QIY ❑ Unit 2 <br /> 4. Street G <br /> ry <br /> 5. Street City ❑ nit 3 <br /> G. Street c <br /> 7• strtet atV (re;7Unit 4 <br /> B. Strert <br /> city <br /> s. street Unit 5 <br /> +0. Street city <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES L; <br /> s� <br /> R UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WAS AGILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY C7 SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL d PUMPER TRUCK/YARD/CHEM TOILETS <br /> CI TATTOOBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION srrFs <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(2 9)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 /> 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. <br /> CONFIRMED APPOINTMENT DATE .. TIME------------- <br /> L4 Will <br /> DATE CONFIRMED PHONE FAX," INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4"2-006 ' <br /> 9/6/2005 <br />