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FROM : .Geo-Phase Envirorme'ntal Inc. FAX NO. 2095690295 dun. 7,9 20065 03:230M P2 <br /> EHD LOC NUMBER <br /> GATE RECEIVED SAN JOAQUIN COUNTY <br /> non E� ��� ENVMOMU rrA B,,,,LTR P�g�s r <br /> 304 E Weber Ave 3 Floor Stockton, <br /> JUN 9 ��0�20°)468-3420 Fall'. (209)464-01,38 VVeb:yvvww.ca .san joaquin,.ca.uslehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> T ,Ia' 4.01 aUsINEMAGENCY: <br /> APPLICANT: <br /> rdr <br /> ADDRESS: <br /> � '�--' <br /> PHONE: FACSIMILE: a' <br /> p <br /> 0161 <br /> TEtffATIVE*APPOINTMENT HATE:(/ _ I Time: <br /> (Fiease allow 10 business days from date Df$APlication submittal) <br /> CHECK SOX TO FXPEI)rM REQUEST-$53.00 FEE-REQUEST PROCESSED IN 3 B 1NESS PAYS <br /> `- DATE <br /> SIGNATURE OF APPLICANT rtment Use only <br /> UTti3' <br /> FILE ADDRESS <br /> Unit 1 <br /> 2et Unit 2 <br /> s, s it <br /> Unit 3 <br /> a. sIr <br /> v;Sl�riit�,�: <br /> T, sheer <br /> a. srree� Unit 5 <br /> 9, sveet . <br /> city <br /> io• SU,eet � . <br /> ENVIRONMENTAL.HEALTH DEP HENT FILES <br /> CLEANUP SIrrE(LOP) E] ROUSING ASATENIFKT ID. SOLID WASTE FACILITY <br /> .'UNDERGixOUND TANTS(U57) CI FOOD FACILITY ❑ SOLiD WASTE VEHICLE <br /> 0 OTHER CLEMUF SITE(NON-LOP) ❑ DOG KENNEL. Q DAIRY <br /> UNDERGROUND TANK(MONITORINGIREIdOVAL) p CHICKEN RMW R PKG:TREATMENT PLANT <br /> 0 HAZARDOUS,,WAM GE.t1ER4'COR 0 rAOTELMOT L d 0Up4P9R RUCKr(ARDICkEVi TOILETS <br /> ❑ TIERED PERNii1TED FACIL" ❑ POOLISPA ❑ LAND USE APPLICATt0 N 5i-I'i=S <br /> 0 TATrOOISOf]Y PIERCING Ci OTHER(P�fi SpEC1 <br /> CI {MEDICAL.WASTE FAGILIYY e <br /> 1. List up to tart addresses to the space above. Select the typQ(s)of f<les from the list above W choc-Wlg <br /> tine appropriate box(es), At least one file type MUST be selected. ax ° 209 454-0138 or mail xa til <br /> address indicated aba e. be confirmed <br /> 2, 1rFiD w:ll <br /> 'applicant applicant if any EHD files sx(st. An appointment ea`review of application.t The files <br /> approximately fare business days but no later than ten(10)days A <br /> will be held for a ma?ftlrlum of fine business days for review, Appointments should be scheduled <br /> ac4ardingly. y available for review. Anew <br /> g. A#ite that is actiYely being wonted on by EHD staff may not be<immedirateiy <br /> appti zation may be submitted when tlas file is available. <br /> elea ed <br /> 4. Any fits not returned in the Sarre condition as released will b�reorglrZi�ed by EHD staff at the expertise <br /> of the applicant. !inure file reviews by the same applicant may require a$93.00 deposit Prior to review. <br /> 6. *TENTATIVE appointment dates rnust be confirmed with EHDfstaif. <br /> �. Applications received after 3:0 pm will be processed the next business.day. <br /> ECONFIRMEP API-OtNTjyIENTDATETIMEXEsX10R1fi6W GA'P E•� - - - <br /> tVe2009 <br />