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..EMM Geo-Phase Erw`irorynentoL FAX NO.• 2095690295 Jul. 26 2004 04:34PM P2 <br /> DATE RECEIVED SAN JpAQUIN COUNTY EHD LOG NUMBER <br /> (� <br /> W(�E(CLQ 9 VEDD EN VIRONMFNAVALdHEALTH DEPARTMENT <br /> 04 E Weber e 3 Floor Stockton, CA 95205 <br /> JUL 2 6 20*09)468-3420 Fax: (209)4640138 Web:www.co.san joaquin.ca.us/ehd <br /> ENVIRONMENT PUBLIC RECORDS RELEASE APPLICATION <br /> P <br /> APPLICAN!&& 1+d BUSiNES31AGENCY:_67es, '0001f"V.fel 4; <br /> ADDRE$$:4 f27 e rsI fi d•! <br /> PHONE:--2& Aea f.l? FACSIMILE: x6"9 4,?IP f' <br /> TENTATIVE'APPOINTMENT DATE: �N Time: <br /> —7�-- �-- <br /> (Please allow 10 bua(neas days from date of application submittal <br /> �IECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINE9 PAYS <br /> SIGNATURE OF APPi.iCANT DATE --- G <br /> DeparItt Use Only <br /> FILE ADDRESS UNIT <br /> i. SacC (� <br /> /-, 0 Unit 1 <br /> s. sum 3.Y.7 gE Car'4i't G'a` cry [] Unit 2 <br /> My <br /> s. <br /> 7. <br /> 'ked CRY n <br /> S. sd"' CRY, Unit 5 <br /> 10 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3HOUSING ABATEMENT Q SOLID W ACILr Y <br /> OTHER CLEANUP$ITE(NON-.OP) ❑ FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL CI DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERM TTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCr4YARDICHEM TOREM <br /> O YATTOOIBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O OTHER(PLEASE GPECIFY) <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)484-0138 or mail to the <br /> adgresAIndigAM above. <br /> 2. EHD 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. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may lie 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 /> S. 'TENTATNE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after.3:00 pm will be processed the next business day. LR <br /> CONFIRMED APPoiNt.-MENT..DATE TIME. <br /> DATE CONFIRMED: _ _ PHQNE . FAX,:. INITIALS* <br /> REVIEWED YES -NO REVIEW DATE <br />