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FROM : Geo-Phase Environmental lam. FAX NO. : 2095690295 •un. E9 2006 03:23PIl P2 <br /> �— EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN CQuNTy <br /> WEN- <br /> �"/ LSD ENVIRONMENTALHEAI TIT DEPARTMENT /'a <br /> 304 F-Weber Ave 3'Floor Stockton, CA 95205 �U <br /> JUN 9 200 209)468-3420 Fax: (2.09)464-0138 Web:www•C0-San-joaquin.ca.us/ehd <br /> 4 <br /> ENVIRONNII[N i HEALTH PUBLIC,PRECORDS RELEASE APPLICATIO/N <br /> — <br /> APPLICANT:—iii ,r�,� <br /> ADDRESS:�����-5.�°�i �^KCn� <br /> FACSIMILE: <br /> PHONE: ---- <br /> TENTATIVE`AFFOINTMENT DATE: T.�C/ j <br /> (Please allow 10 business days from date of application submittal) <br /> L1 ( CHECK BOX TO EXPEDITE REQUEST.$fl3,00 FEE–REQUEST PROCESSED IN 3 B INESS PAYS <br /> SIGNATURE OF.APPLICANT (DATE <br /> PLICANT ,� / <br /> D2nment U58 Only <br /> FILE ADDRESS FIVn <br /> �0� k/ /S«rty Fel G 6a <br /> rr /i <br /> x. <br /> 7. �,beG ENVIRONMENTAL HEALTH DEP TMENT FILES <br /> 25 UNDERGROUND YANK(UST)CLEANUP S?TE(LOP) ❑ HOUSING ABATEMENT <br /> P) ❑ FOOD FAGIt.I'1'1' ❑ SOLID WASTE VEHICLE <br /> ,Z OTHER CLEANUP SITE(NON-1-0 <br /> UNCERGROUND TANK(MONIT(RING)REMOVAL) E3 DOG KENNEL 17 DAIRY <br /> clHAZARDOUS WASTE GENERATOR R CHICKEN RANCH in PKQ TREATMIEN'r PLANT <br /> ❑ TIERED PERMRTED FACILRY ❑ MOTELlHOTEL ❑ PUMPERTRUCK/YARDlCHEN TOILETS <br /> O TATT001800Y PIERCING ❑ POOUSPA ❑ LSJ1D USE APPLICATION SRES <br /> El MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)-------, <br /> 1, List up to ten addresses In the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0133 or mril ko the <br /> address indicated above. <br /> 2, EHD wilt 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 fifes <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 /> ap,all-xtion 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 /> FOATE <br /> NFIRMED AnPoiNrpHEN7.DATE <br /> TIME -- <br /> CONFIRMED, f?l{.QNE FAX.. INMIALD <br /> IEYJI D YES NO <br /> REVIEW DATE^.. — <br /> EHQ<BA2nBb J <br /> !VB(xWS <br />