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ROM : Geo-Phase Environmenta&c. FAX NO. : 2095690295 ` Sun. 24 2004 04:14PM P2 <br /> EHD LOG NUMBER <br /> ECEIVEo SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 4 2004 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> (2p9�468-3420 Fax: (209)464-0138 Web:www.co,san joaquin.ca.us/ehd <br /> ENVIRONIVVEP 1 I tAL H IV <br /> PERNMSERVICES PUBLIC RECORDS RELEASE/APPLICATION <br /> LQ',y YAG <br /> BUSINESS/AGENCY: L:; lA49fe je!5 <br /> re '+f "' e` <br /> APPLICANT: ,,I <br /> ADDRESS: �^ p M o y a —a-t <br /> PHONE: 7 °f/ 4?A FACSIMILE: <br /> ^ TENTATIVE'APPOINTMENT DATE:/�A Time:A� <br /> (please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED I BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Pepadb enl Use Only <br /> FILE ADDRESS IT <br /> so-eec '✓ aZr c Unit � J <br /> 2. Skeet y v <br /> 9. safer 4� w •! G 4-e 9 Unit 2 <br /> <. s5 B c, v <br /> 5. Sweet <br /> D Unit 3 <br /> 6. Sacs <br /> r. So-aOt a <br /> Unit <br /> a <br /> e. saw C7 <br /> c, Unit 5 <br /> 10. aVeot r11 G 'k ' 2Oc Y <br /> < o . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES § �p <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3HOUSING ABATEMENT SOLID WASTE <br /> .Z THEIR CLEANUP SITE(NON-LOP) L3 FOOD FACILITY ❑ SOLID WASE VEF 1{1C__ _p 1 ..i9 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> OHAZARDOUS WASTE GENERATOR ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ MOOLIJHOTEL <br /> O TATTOOIBODY PIERCING ❑ A LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER THER(PLEASE SPECIFIC <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 mail to the <br /> address indicated 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 be 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 /> g• *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Applications received after 3:00 pm will be processed the next business d <br /> CONFIRMED APPOINTMENT DATE <br /> TIME IY° <br /> DATE CONFIRMED PHONE . FAX ' INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 110�e-03-0oc <br /> 0lYZOoi <br />