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FROM : Geo-Phase Environment Inc. FAX NO. : 2095690295 . Jan. 13 2004 10:24AM P2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> I 1 �� � ����J <br /> >J - <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 I l� <br /> jAF,l '13 •_('(409) 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/chd 16 <br /> �J <br /> �NWA'01d"I9LHI HEALTH, PUTBLIC RECORDS RELEASE APPLICATION I <br /> APPLICANT:5--Zh?E 14 ax(tyDrc� BUSINESSIAGENCJYyW"r +'7y <br /> ADDRESS:,�-7 T 41 y P-ea^+Q <br /> PHONE: S'6�j 5 i2 'Z7 -3 __FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: /�Yi ��� Time: At�! ._ <br /> p�q� (Please allow 10 business days from date of applicatlon submittal) <br /> O _CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE / <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> Strom 4-0.0,e Zeyyye cl ❑ Unit 1 <br /> z. Sued d• G �'�/ra <br /> Unit 2 <br /> saeoi d <br /> s. sweet <br /> oty ❑ nit 3 <br /> 6. Svea C <br /> S,re, 4il 4 <br /> B. SUeeI D <br /> s strea a Unit 5 <br /> 10. Street city <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT ❑ SOLID WA4 ACILITY <br /> )<, <br /> .ol OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 17 SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TATfOOrBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <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(209)464-0138 or mail to the <br /> I <br /> ddress 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 /> 5. '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 /> d <br /> CONFIRMED APPOINTMENT DATE TIME <br /> Ila <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED .. YES NO REVIEW DATE <br /> EHD6 2406 <br /> a Qw <br />