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FROM : Geo-Phase,Environmental FAX NO. : 2095690295 Apr. 21 2005 10:42AM P2 <br /> ".g END LOG NUMBER <br /> a� u I j�? SAN JOAQUIN COUNTY <br /> ENVqR.ONMENTAL HEALTH DEPARTMENT -7 <br /> }SPR �, f ?n0q 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> EPi�Vil Ot M,ENT ��C 4 8-3`20 Fax: (209)464-0138 Web:tivww.co.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ` /' BUSINESS/AGENCY: <br /> 4_2 vO <br /> ADDRESS: 4� <br /> PHONE: 0 FACS1MtLE: <br /> TENTATIVE*APPOINTMENT PATE: Time: <br /> (Piease allow 10 business days from date Of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-•REQUEST PROCESSE 3 BUSINESS DAYS <br /> DATE �J <br /> SIGNATURE OF APPLICANT Qep vnent Use OMY <br /> UNIT <br /> FILE ADDRESS <br /> ct ❑ Unit 1 <br /> Or,] Un <br /> �Q <br /> G GA <br /> 4. su"I �f C <br /> 5. sheet <br /> atT. Streeta. cued <br /> g, &Ueet <br /> f0. Strcc� <br /> E=NVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d HOUSING NUS H <br /> ABATEMENT In SOLID WASTE FACI <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 "()USFOOD FACILITY C3 SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) D DOG FACILITY <br /> Cl DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR p MOTEL/HOTEL PUMPER TRUCKlYARD/CHEM TOILETS <br /> O TIERED PERMrrTEO FACILITY d POOLISPA ❑ LAND USE APPLICATION SITES <br /> O TATTOO/BODY PIERCING ❑ OTHER(pLEASE SPECIFY) <br /> O MEDICAL WASTE FACILITY <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 abpop e• y ointment for review will be confirmed <br /> 2. EHD will notify thea applicant if an F-HD files exist. An app <br /> approximately five business days but no later than ten(10)days aofter receipt <br /> should pbe scheduled f les <br /> will be held for a maximum of five business clays for review. App <br /> accordingly. <br /> v <br /> 3. A fife that Is actiely being worked on by EHD staff may not be immediately available for review. new <br /> application may be submitted when the file is available. at <br /> ense <br /> 4. Any file not returned re file reviews by the same applicant may rehe same condition as releaSed will be quire a$93,00 deposanized by EHD it staff priori to review <br /> of the applicant. Fu <br /> 5. (TENTATIVE appointment dates must be confirmed with FHD staff. I <br /> 6. Applications received after 3:00 pm will be processed the next business da <br /> TIME <br /> CONFIRMED ApRO1NTMENT-DATl= . <br /> - . ::`.PHONE .' FAX,'- INITIALS <br /> DAT(:CONFIRMED <br /> NO REVIEW DATE-. <br /> REVIEWED ,_ YES - <br /> EHD 4E-02.006 <br /> BfQl200s. <br />