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FROf1 Geo-Phase Environmental to('' # FAX N0. : 2695690295 '�•. 02 21303 09:11AM P2' <br /> Ll,, <br />` <br /> ;":: � - SAN JOAQUIN COUNTYPUBLIC HEALTH SE RViCI:_S <br /> Its+,�f :� r��� <br /> I ;, �Y� ENVIRONMENTAL HEALTH 01VIS101`4 <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> JUN 0 2 2003 STOCKTON CA 05202 <br /> (200) 438-3420 <br /> _ AW_H PUBLIC RECORDS RELEASE APPLICATION <br /> PERN,11T�/ ERVICES n <br /> APPLICANT_ _ d 2 F Q-^► rl� �r - SUSIXESSIAC�ENCY �'�d/��S"E .i�"�?►��'�^^� <br /> ADDRESS gf_2Z. <br /> PIigNZ. 6"a,9 ,.0�-?_3 FACSETA!>,C� � � az F __..._.....----•--- I /J_., R'Z 1 QV 5 <br /> TENTATIVE`APPOINTMcNT QATE fS _ TIME _ <br /> (Please Ove 7(o 10 bus-sncss uayn from datr of application submillal)T__._ <br /> �CFi>=C:K BOX 70,EXPEDIT>;ftCCIUIiST-$0.00 FLEE–RE•RULST PROCESSED IN 3 BU5iNCS5 DA'f5 <br /> SIGNATURE OF APPLICANT � ��lee ���.•�� VAT <br /> FILE ADDRESS THIS SIDETHO ST%FF;JS,C OftLY <br /> Plis�GFtAt9 C:LErArNYs SL"Ak�t1 <br /> r /SC &?L--, J — T 4,Z. —.98 41 —� <br /> W 11 ad j <br /> i <br /> i- <br /> ENVIRONMENTAL HEALTH DIVISION FILLS <br /> XVNDERGROUND TANK(UST)CLEANUP SITZ.(LOP) 0 iiou5IN'3 AbATEML-NT CD SOLID VVA:iTE FACILITY <br /> `❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY {D 501.1D WA:TL• VE'_MCLE- <br /> uNDERCROUND TANK(MONITORINGIRCMOVAL) ❑ DOG KENNEL O DAIRY <br /> O HAZARDOUS YVAS GENERATOR 0 CHICKEN RANCH C1 PKG TREn'.'MENT PLANT <br /> ❑ TIERED PERMM. FACILITY a t40TEIIH0T5L ❑ PUMPERIRVU '. %AARGICHEMTOILETS � <br /> 0 TATTOOiBODY P91RCING 11 Pd0L15`'A 0 LAUD USC-4PPLIC:ATION SITES <br /> C MEDICAL WASTE FACILITY ❑ PL15LIC WATER SYSTEM 0 OTHER(PL�_'ASI: PECIFY AILOVE) <br /> 1. List up to ten addresses in the space above. Select the types)of flies;*.roll tho li.t aboYe by chcckinj <br /> the appropriate box(es). At least one file type: MUST be selected. Fax t:j (:d-493_464-0:138 or rn.Atto the 1 <br /> address indicated above. <br /> 2. EHO will notify the applicant if any EHD flies:xisL An appointment for review will be confirmed <br /> approximately five business days but no later•than ten(10) days after.rrceipt t,f application. The Was <br /> will bo hold for a maximum of five businlrss days for review. Appointm,ml:s should lie scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by !`HD staff may not be immadia.tely 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 ;in released will be rcorganLted by EHD;taff at the cxponse <br /> of the applicant. Futuro file reviews by the s<.me applicant may require a S87.(0 deposil:prior to review. <br /> 5. *TENTATIVE appointment dates must be cone'irmed with EHD staff. <br /> S. Applications received after 3:00 pini will be processed the next business day. " <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED FHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATF � — <br />