Laserfiche WebLink
FROM Geo-Phase Environmental Inc. FAX NO. : 2095690295 ''pian. E9 200E 03:23PI`1 P2 <br /> • EMD LOG NUMBER <br /> DATE gECEIVED SAN JOAQUIN COUN'T'Y <br /> ENVIRONMENTAL HEALTH DEPARTiVIENT <br /> 304 E Weber Ave P Floor Stockton,CA 95205 <br /> JUN 9 260K201)458-3420 Fix: (2.09)464-0138 Web:www.co.san joaquin.ca.uslehd <br /> bq4 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P <br /> n EUSINESSIAGENCY: •�rv! <br /> APPLICANT:_ "._- � .._— <br /> Ar <br /> ADDRESS: <br /> PHONE, FACSIMILE: <br /> TE NTA Time: Z- <br /> TDYEt APPOINTMENT OATE:.LS�...... <br /> (piease alloy 10 bUSI11e35 days from date of aPPlWMIOn submittal) <br /> C9 CHECK BOX TV EXPEDITE REQUEST.$J�3.00 FEE-REQUEST PROCESSED IN 3 B INESS PAYS <br /> IRATE <br /> SIGNATURE OF APPLICANT �,� <br /> /� rtment Use t]n!y <br /> uNtT <br /> FILE ADDRESS <br /> C7. Unit 1 <br /> 2. <br /> �r ef p unit 2 <br /> ftlitil/ .00, y <br /> 4 <br /> c� Unit 3 <br /> 5. S rem <br /> � tJl'�it <br /> 7. net <br /> C� <br /> Unit 5 <br /> 9. 5lreat <br /> q <br /> 10, S4eet <br /> F-tWIRONMENTAI.HEALTH pep MENT FELE$ <br /> UNDERGROUND TANK(UST)CLEANUP SF*fE(Ldp) E30 HOUSING A13ATP-MF-KT 0 SOLID WASTE FACILITY <br /> C! FOOD FAGILrrY SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 13 <br /> DOG KENNEL C3 DAIRY <br /> )ErUNCERGROUNDTANK(MONITORINGIREiAOVAL) ❑ CHICKEN RANCH ❑ pKCTREATMp_NTPLANT <br /> d HAZARDOUS WASTE GENEMTOR M INOTELiHO'ML O PUMPER TRUCKryARUiCHEM:TOILETS <br /> 13 TIERED pERMi'ITED FACiLnY ❑ pOpL[SPA 0 LAND USE APPLICATION SrrES <br /> ❑ TATTOO(60DY PIERCING 13 OTHER(PSE SpECi <br /> 13 MEDICAL WASTE FACiLrrY <br /> 1 List up tQ ten addresses in the space above. Select the type(s)of files from the list above by ahecHng <br /> the appropriate box(es). At least one file type MUST be selected. ax to 208 464-0138 or ma_I co N'_% <br /> address indicated above. <br /> 21 E D w:11 notify the applicant if any EHA 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 /> accordingiy. EHD staff may not be immediately available for review. A rie�M <br /> 3. Afile that Is actively being worked on by y <br /> application may be submitted when the ti[e is available. the <br /> 4. Any fila not returned in the sante condition as released will be reorganized by EHD staffa riot eY. <br /> revns e <br /> of the applicant. Future file reviews by the same applicant may require 3$93.00 deposit p <br /> 6. *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 /> • '•' 1f lME . <br /> EDATECONFIRIMED <br /> l li7 1F'f_0f 1,&jIIENT.DAVE <br /> FAX.. INITIhi:�' <br /> '�.. 1M& NO ftty N DATE <br /> sHcte•wt-0ob —r ' <br /> areriova <br />