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FROM.: Geo-Phase Environmental Inc. FAX NO. : 2095690295 ,tn. E9 2006 03:23P1`1 P2 <br /> FHD LOC NUMBER <br /> [)ATE RECEIVED SAN JOAQuiN Coo NTY <br /> E C E�Y/E D EWMONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> JUN 9 2d0&209)468-3420 Fax: (2.09)464-0138` &I www:C0-San-joagU n.ca..us/ehd bq4 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> '� <br /> P BusINESSIAGENCY: ���Oz;w <br /> ADDRESS. �t et.g el i"' <br /> PHONE: ���P� ? FACSIMILE: 7 d' <br /> TE TrATIVE;APPOiNTmeNT DATE: Time: <br /> (Please allow 10 bttSlnesa days from dat9 of application submittal) <br /> 1 <br /> CHECK BOX TV EXPEDITERECIUESY'-$93.00 FEE—REQUEST PROCESSED 1N 3 B (NESS p �S <br /> AY <br /> SIGNATURE OF APPLICANT 97ATE L .�- <br /> rtrrtent Usa[)n!y <br /> UNIT <br /> FILE ADDRESS <br /> ,. <br /> el Al /� h Ev (3 Unit 1 <br /> z. Ar er ❑ Unit 2 <br /> s. s fir <br /> �i <br /> Unit 3 <br /> 5. Street $,. r 4• . <br /> 7. 3"et <br /> a. strm [a Unit b <br /> @. Street <br /> 14. r>treet <br /> ENVIRONMENTAL-HEALTH DEP MEN'S FILES <br /> TY <br /> 4'UNDERGROUND TAMC(UST)CLEANUP SFTS(LOP) O HOUSING ASATEMt:NT ©. SOLID WASTE VEHIFACICLE <br /> © FOOD FActLfrY CJ SOi.il}WASTE VEHICLE <br /> , OTHER CLEANUP SITE(NON-LOP) ❑ FOO KENNEL AgLl ❑ DAIRY <br /> UNDERGROUND TANK(MOWORINGIREMOVAL) ❑ CHICKEN RANCH ❑ pKC TREf1TMFNT PLANT <br /> d HAZARDOUS WASTE GENERATORd rAoTEUHOTEL d PUMPER TRUCKIYARDICHEW TOILETS <br /> 4 TIERED PERMnTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 TATTOO15ODY PIERCING 0 OTHER(PLEASE SpECi <br /> la MEDICAL WASTE FACILITY <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. Pax to 209 454MZS or mailo to <br /> address indicated above. <br /> 2. EI{D wall notify the appticant if any EHO files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten('l())days atter 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 /> g. A file that Is actively being worxed an by EHD staff may not be immediately available for review. A Tiew <br /> application may be submitted when the file is available. <br /> 4.. Any file not returned in the sable condition as released mayrequire ra $93.00nized by Hdeposit prior to review, <br /> of the applicant. 1~utura fife reviews by the same applicantY <br /> 5. *TENTATIVE appointment dates must be confirmed with EHL]staff. <br /> 6. Appi€cations received after 3:00 pm will be processed the next business day. <br /> .....,ENT.DATE _ <br /> CONFIRM <br /> A[il?O.[tTlyl :....., <br /> TIME .•." <br /> DATE CONFIRMED'. 0'ONE FAX <br /> REVIEWED YES Na Rl�Vi1=1N UATE <br /> ti7d@1�4A <br />