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FROM-: Geo-Phase Environmental FAX NO. : 2095690295 E9 2006 03:23PM P2 <br /> EHD LOG NUlA3ER <br /> PATE gECEIVEO SAN JOAQUIN COUNTY <br /> W LSD U W LS ID ONMENTa MA LTII DEPARTMENT <br /> 9 <br /> 304 F'Weber Ave 3 Floor Stoc , <br /> JUN 9 E00poo)468-3420 Fax: (2.09)464-0138 Web-,www.co.sau joaqu"Lea-uslehd <br /> ENVIRONMEN I HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P �^- <br /> AP>$LlC,AIdT:_,�Z �- � StJStNESSIAGENGY: ��'•r'�' <br /> e Ave <br /> ADDRESS: �e^� <br /> PHONE: f � FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE" <br /> Time: <br /> (Meese allow 7o businass days from date of aPPiicM16n submittal) <br /> CIIECli BOX.TO EXPEDITE REQUEST-$93.00 Fee!REQUEST'PROCESSED IN 8 B (NESS PAYS <br /> ,. DATE .� 9 <br /> SIGNATURE OF APPLICANT rtment Uas OnlY <br /> FILE ADDRESS UNIT <br /> d A,/ «� •" Cl Unit 1 <br /> x. tream � !f <br /> Unit 2 <br /> s, SVGr <br /> 5. <br /> S"M <br /> s. saoet ~Un'tt 4 <br /> Z, street <br /> s. Stmt Unit 5 <br /> ENVIRONMENTAL.}HEALTH DEP MENT FILES <br /> M. SOLID WASTE FACILITY <br /> Z UNDERGROUND TANK(UST)CLEANUP SITE(,.og) O HOUSING ABATEMENT Q SOLID WASTE VEHICLE„1'd'”OTHER CLEANUP SITE(NON.LOP) ® FOOD FACILITY 0 DAIRY <br /> Zr UNDERGROUNl)TANK(MONUORINGIREIVIOVAL) ® DOG�N�- r3 pKe TREATMF-NT PLANT <br /> D HAZARDOUS WASTE GENEMYOR C3 CHICKErNN RANCH <br /> CI TIERED PERMnTED FACILITY 0 MOTELIHOTEL M PUMPERTRUCLICATION Sr TOILETS <br /> Ci TATTOOlBOpY PIERCING n POOLISPA ® LAPID USE APPLICATION SiT1=S <br /> 0 MEDICAL WASTE FACILITY OTHER(i'I EAS6 SPEGi <br /> 1, List up to ten addresses in the space above. Select the type(s)of files from the list above fey cheelong <br /> the appropriate box(es). At least one file type MUST be selected. to(2g8�464-0133 ormail to t°h <br /> address indicated above. <br /> g, EHD wall notify the applicant if any EH&3 files exist. An appointor after raced t of a I bt cation he files <br /> approximately five business days but Ito later than ten(10)days p pP <br /> will ba held for a Ina mum of five business days for revievw. Appolcltments should be scheduled <br /> accordingly. y EHD staff may not be immediately available for review. A r ev' <br /> 3. Afile that is actively being worXed on by Y <br /> appll=tion may be submitted when the file is available. <br /> q.. Any file not returned In the sande 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. NTATIVE appointment dates must be confirmed with EHD staf--F. <br /> 6. Applications received after 3:00 Pm will be processed the next business day. <br /> .• SSSS..:. .. .•. • <br /> CONFIRMED APfiP"ENTDATE % , , NITi6 <br /> 7. <br /> DATE CONFIRNi�D <br /> E?lit�CE . FAX-.. .• t .,,_ _ •. <br /> RMI~t� �-. SEs Na �rr�llvv DATE <br /> t:HQ 4BA2-0e6 <br /> $moos <br />