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M Geo-Phase Environmenta' 'nc. FAX NO. 2095690295 Jun. 01 2004 10:02AN P2 <br /> EVVb© ;,I "� `! EHD LOG NUMB <br /> J J VfSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 0 1 2004 304 E Weber Ave P Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web:www.co,sa*n-joaquin.0a.uS/ehd <br /> ENVIRGNI LN7 HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. <br /> �j�7 'dcd �d+t !'�G7 BUSINESS/AGENCY:_� �61- <br /> v es:° <br /> ADDRESS:g!?:�7 !/e�y�s et-14,:2f ode � ,90R ya <br /> PHONE: 66"r �/�`l FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: /F" J^ / y Time: <br /> (Please allow 10 business days from date of application submittal) <br /> �ktECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BU ES5 DAYS <br /> SIGNATURE OF APPLICANT DATE / <br /> Department Use Only <br /> FILE ADDRESS J� UNIT <br /> }_ Strcct -/&a/- G �t( a <br /> z. s r«t 23d Co 035 - <br /> Unit 1 <br /> 3. seat G 1• 35d'(Unit 2 <br /> 4. Strcct aty <br /> S. strttt atyC] Unit 3 <br /> B. Street aty <br /> 7. Street City Unit 4 <br /> 6. Strcct Lity <br /> 9. Street G _ Unit 5 <br /> 10. street Chy <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> El ❑ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASA f� <br /> ;COTHER CLEANUP SITE(NON-LOP) p FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTF GENT=BATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 0 PUMPER TRUCKlYARD/CHEM TOILETS <br /> U TATTOOIBODY PIERCING ❑ POOUSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE 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 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 /> 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 /> CONFIRMED APPOINTMENT.DATE .: TIME <br /> DATE CONFIRMED PHONE FAX-.' INITIALS <br /> REVIEWED YES NO REVIEW DATE. <br /> t:t w sa-0x-ouc <br /> elRt7oei <br />