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FROM : Geo-Phase Environmental Inc. FAX NO. : 2095690295 Dec. 24 2002 12:03PM P2 <br /> �A i �Ii_' IaQN J QUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC 2 4 2002 304 EAST WEBER STOCKTON THIRD FLOOR <br /> CA 05202 V <br /> (200)488-3420 <br /> ENVI;Qi„l";E i ;Er (PUBLIC RECORDS RELEASE APPLICATION <br /> AP <br /> APPLICANT 44e4f BUSINEssiAGNCY Oe <br /> ase� i <br /> ADDRESS 993 ry f e+f A <br /> PHONE r •DA 913 <br /> TENTATIVE'APPOINTMENT DATE ��I3I A TIME <br /> �p�(�� (Please five 7 to 10 busines days Irom date al application submittal) <br /> Vim-* CHECKBOx TO,EXPE•DITE RE-QUEST-$07.00 FEE-REQUEST PROCESSED IN S UUSINESS OATS <br /> SIGNATURE OF APPLICANT � /� "e- � DATE f' o L <br /> r FILE ADDRESS THIS SIDE EHD STAFr•US -g{LY - <br /> -y PROGRAM ELEMENTS S <br /> / .4. S *A f N • C/COM//J <br /> s 4/ <br /> 3rS .F r ^ SJG <br /> d 14po,,reC frfE ^SJG <br /> 5I Wi.`sr L �/ Ds a/o — /✓ r <br /> I <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> (1Z� NDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT O SOLID WASTE"FACILITY <br /> :Q OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASE GENERATOR ❑ CHICKEN RANCH C3 <br /> PKG TREATMENT PLANT <br /> u TIERED PERMITTFj FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIARCING ❑ POOUSPA -- D LAND Use APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER^V.A5E SPECIFY ABOVE) <br /> 1. List up to ton 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 ton (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$87.00 deposit prior to review. <br /> 5. '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 /> I <br /> �I CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> I <br /> REVIEWED ; YES NO REVIEW nATF <br />