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FROM : Geo—Phase Environmental,,R.ic. FAX NO. 2095690295 Apr. 21 2005 10:42AM P2 <br /> END LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENYTRONMENTAL HEALTH DEPARTMENT -7 <br /> APR I ?nog 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> `�22�09 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT Fi( ALTH <br /> PERPh1T./SE9VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: '�� L "�('�r� BUSINESSIAGENCY: <br /> ADDRESS' <br /> �y FACSIMILE: �� <br /> PHONE: rJ'� � 4�,� - _ — <br /> TENTATIVE'APPOINTMENT DATE: �py Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSE 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use OnlY <br /> FILE ADDRESS UNIT <br /> C+ ❑ Unit 1 <br /> strn G a ❑ Unit 2 <br /> 4. Strret �� <br /> s. street qt bUn <br /> ct <br /> c <br /> 8. Strscy <br /> B. Sweet <br /> G ❑ Unit 5 <br /> 10. Strcct G <br /> ty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACT <br /> E?V q5h fl <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL D DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY C1MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING d POOL1SPA 173 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PRASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)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 da <br /> CONFIRMED App OINTMENT.DATE t TIME <br /> PHONE FAX INITIALS ; <br /> DATE CONFIRMED . . . <br /> REVIEWED YES NO REVIEW DATE ` <br /> EHn 48-02-000 <br /> RMRfI(ll <br />