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FRON Geo-Phase Environmental Ir� FA'; NO. . 209' G9029'5 T.AFI. VJ <br /> SAID! JOAQU COUNTYPUBLiC HEALTH SERVIG� U <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON GA 95202 <br /> (209) 468-3429L W kL <br /> PUBLIC RECORDS RELEASE APPLICATION U�y 9 <br /> -1N 00 <br /> APl=LIGANT wk-7ArlSa.-� EIUSINESS1AGENCY G o , ESVsRo.�t t.Lt�gpC��hAF '�f�ryEA�r <br /> PHONE -Ze Y- (.� ��` �� FACSIMILE <br /> TENTATIVE;'APPOINTMENT DATE _ � TE <br /> (Please give 7 to IM10 business days from dale of application submittal) <br /> © <br /> CHECK BOX TO EXPZDITE:REQUE=ST-S79-00.FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT "' `" L DATE <br /> FILVIADDRESS it <br /> :;23b <br /> enc; ,\ ��." >� 11 tit 11 ✓` . 0 L D <br /> -2':�� <br /> ij <br /> f i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 5a UNDERGROUND TANK{UST)CLEANUP SITE(LOP) R HOUSING ABATEMENT C3 5OLI0 WASTI!rAGILITY � <br /> 0 OTHER CLEANUP SITE(MON-LOP) O 5000 FACILITY ❑. SOLID WASTE YEKICLE I <br /> Q UNDERGROUND TANK(MON ITOMNWA EM OVAL) 0 DDG KENNEL Q DAIRY <br /> 2 HAZARDOUS WASTE GENERATOR U CHICKEN RANCH 0 PKG TREATMENT PLANT � <br /> 0 73EREb PERMITTED FACILITY d MQTEt1HOTEL » PUMP8RTRUCKIYARDfCHEM TOILETS <br /> Q TATTOCII300Y PZ;RGING © PQOLISPA 0 LANG U5EAPPLICATI0iV SITES <br /> Q MEDIGALIVASTr FACILITY 0 PUBLIC Y+IATIaR SYSTEM. ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to*ten addresses In ttte space above. Select the typos) of files Trom 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 /> 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. p <br /> 3. A file that is activeiy being worked on by F_Hi3 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 $78.00 deposit prior to review. <br /> S. 'T'ENT'ATIVE appointment dates must be confirmcd with EHP staff. � <br /> E. Applications received after 3:00 pm will be processed the next business day. <br /> } <br /> CONFIRMED APPOINTMENT DX-rF: TIME <br /> DATE CONFIRMED PHONE FAX INITIALS �--- <br /> REVIEWED YES NO.. REVIEW DATE <br /> Ek OE 14 0110 40 <br />