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FROM Geo-Phase Environmeno I nc. FAX NO. : 2095690295 Jan. 27 2005 09:47AM P2 <br /> VAI t ntUlYtO ENO 40G NUMBER. <br /> RECIE V ED <br /> SAN JOENVI IN COUNTYPUBLIC HEALTH ONMEN AL HEALTH D VISION VICES <br /> V 304 EAST WEBER AVENUE,THIRD FILOOR I <br /> i 2 7 7n05 STOCKTON CA 95202 <br /> ENVIRONMENT HEALTH (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> - <br /> APPLICANT P. TO BUSINESSIAGENCY,(�-�J ��a-rte' G�'!/fYdyvl+•+/s• 'T4� <br /> ADDRESS �.w C an of 22 40!e— <br /> PHONE - FAdSIMILE <br /> TENTATIVE`.APPOINTMENT DATE CTIME !' <br /> (Please give 7 to 10 business days from data of l plicffiion 5UtMittel) <br /> CHECK BOX TO EXPEDITE REQUESTT-$$39.00 FEE-R QUEST PROCESSED IN 3 SINESS iDAYS1 Y <br /> SIGNATURE OF APPLICANT DATE / G <br /> i <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> OdP. Gr/ +re SlAl <br /> Ar-u <br /> -41 <br /> mt " 1 <br /> if dG C119 40Q 9W J, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LAP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> OC HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILRY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY FORCING El POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY t O PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of file s from the list above by checkin! <br /> the appropriate box(es). At least one file type MUST be selected. Fac to (2091464-0138 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 tan (10)days site 7 receipt of application. The files <br /> will be held for a maximum of five business days for review. Appoin ments should be scheduled <br /> accordingly. <br /> 3. A file that.is actively basing worked on by EHD staff may not be immediately available for review. A no <br /> application may be submitted when the file is available. <br /> 4. Any file not returned 16 the same condition as released will be reorg nized by EHD staff at the expens <br /> of the applicant. Future file reviews by the same applicant may requ re a$89.00 deposit prior to rovie <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 />