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� <br /> FROM Geo-Phase Envirorunental FAX NO. : 2095690295 ov. 26 2002 12:36PM P2 <br /> 07 <br /> Fl�N JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION -76 <br /> NOV 2 6 20OZ 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 9TQCKTON CA 05202 <br /> HEALTH (209) 453-3420 <br /> HVII )[["MEN <br /> PRIMIT/SERVIC[SpUBLIC RECORDS RELEASE APPLICATION <br /> 13U S IN LSSIAGENCY <br /> APPLICANT <br /> ADDRESS ia!?.3 7 AvkW4��" e <br /> Q.Y. FACSIMILE <br /> PHONr <br /> L ks <br /> TENTATIVE'APPOINTMENT DATC TIME <br /> (plcasc Vivc 7 to I 0`buainc�:day!;(tom a3le Qi.)PI31ication submitial) <br /> EE-REQUEST PROCESSED 313USINLSSDAYS <br /> CHECK BOX T0,EXPEDITE:REOUE5T-$87.00 F <br /> DATE <br /> SIGNATURE OF APPLICANT 4� Ile <br /> STAFF USE ONLY <br /> SiDr- Clio �� <br /> Ill QoRess PROGRAM ELEMENTS SEARG <br /> 6/1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING A13ATF-MENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ) 0 DOG KENNEL 0 DAIRY <br /> 54 UNDERGROUND TANK(MONITORINGIREMOVAL 0 PKG TFILATMENT PLANT <br /> 0 mAZARDOU5 WASY-5-GENERATOR 0 CHICKEN RANCH 0 PUMPER TRUCKIYARDICKEM TOILETS <br /> 0 TICKED PERMITT��FACILITY 0 tAOTEUHOTEL <br /> 0 POOL/SPA 0 LAND USE APPLICATION SIYI:S <br /> El TATToolsoDY POIRCING0 PUBLIC WATER SYSTLM F-3 OTHER(PLEASE SPECIFY ABOVE) <br /> 0 MUDICA1.WAST9 FACILITY <br /> List up t.0 tell addresses in the space above. Select the typQ(S) of files from the list above by chQGkino <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 4134-0138 or mail to the <br /> -IddreSS 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 hold for a maximum of five business days for review. Appointments should be Scheduled <br /> accordinoly. <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 SZMO condition as released will be reorganized by EHD staff at UIC CXPQnSC <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 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 day. <br /> i <br /> 1 CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMEn PHONE FAX INITIALS <br /> FEVIEWED YES NO REVIEW DATE <br />