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I.9 <br />11/17/2003 16:16 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br />T ECEIYEQ-.,;. ,. <br />cnv LUGivvawu� <br />o (�: L �,`; SAN JOAQUIN COUNTY <br />IC' `! <br />ENVIRONMENTAL HEALTI3 DEPARTMENT <br />NOV 1 2 304 E Weber Ave 3'4 Floor Stockton, CA 95205 <br />468-3420 Fax: (209) 464-01:38 Web: www.co-san-joaquin.ca.us/chd <br />ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Didrik Johnck BUSINESS/AGENCY: Geofogica <br />ADDRESS: 594 Howard Street, Suite 400 <br />HONE: 415-297-7903 FACSIMILE: 772 <br />TENTATIVE' APPOINTMENT DATE: <br />Time: <br />(Please allow 10 business days from data of application submittal) <br />u CHECK BOX TO EXPEDITE REQUEST - $9A001 F - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />rL7 rZ <br />I,quv [i1 JJ <br />11/17/03 <br />Department Use Only <br />UNIT <br />® Unit 1 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />"UN ERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />❑ TIERED PERMITTED FACILITY <br />❑ TATTOOIBODY PIERCING <br />-PY❑ MEDICAL WASTE FACILITY <br />Q Unit 5 <br />_ 3 <br />1, <br />❑ HOUSING ABATEMENT a SOLID WASTE FACILITY <br />❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br />❑ DOG KENNEL ❑ DAIRY <br />O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />O MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILET <br />C.1 pOOUSPA ❑ LAND USE APPLICATION SITES <br />❑ 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 />nfirmed <br />2. EHD will notify the applicant if any EHD fifes exist. An appointmentdays <br />for review will bhe files <br />approximately five business days but no later than ten 10 da s after receipt of application. <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 <br />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 />S. Applications received after 3:00 pm will be processed the next business day. <br />FIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED •= YES <br />ww"03 <br />TIME <br />PHONE . FAX INITIALS <br />NO REVIEW DATE <br />