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FROM : Geo-Phase EnvironmentaC. FAX NO. : 2095690295 Apr. 05 2006 09:25AM P2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Z %7 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: d <br /> ADDRESS:O^9.�7�rML�'�"tidd�F`7 A-"me' . <br /> PHONE: FACSIMILE: 6-C-941 X <br /> TENTATIVE*APPOINTME14T DATE: !/// Time: W117 <br /> (Please allow 10 business days tom date of application submittal) <br /> l CHECK BOX TO EXPEDITE REQUE­V $93.00 FEE REQUEST PROCE ED IN 3 BUSINESS DAYS <br /> fi G.�.- <br /> SIGNATURE OF APPLIG DATE <br /> Department Use Onl� <br /> FILE ADDRESS UNIT <br /> so66 S w <br /> ❑ Unit 1 I <br /> Z 31met CKY <br /> 3. Street G ElUnit 2 'O <br /> 4. SVeet <br /> s. su"t city Unit 3 <br /> 6. ftoe city oe <br /> r. SVW CRY <br /> tilllt 4 <br /> s. 8V acy <br /> 9. sue" a ❑ Unit 5 <br /> ia. sueu <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) r7 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> X OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> j=.'UNDERGROUND TANK(MONITORING/REMOVAL) IM DOG KENNEL ❑ DAIRY <br /> 1X HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PIMP SPECIFY) <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. Fax to(209)464-0138 or ma_ii to the <br /> address indicated above. <br /> 2. EHO 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. <br /> 3. Afile that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the fila 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 /> S. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED AP QififMENT DATE :. . TIME <br /> DATE CONFIRMED PJ3PNE FAX-' `INITIALS' <br /> REVIEWED YES NO REVIEW DATE. <br /> E11�48-01L86 <br /> 481100] <br />