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rJM : Geo -Phase Environmental FAX NO. : 2095690295 ar. 14 2005 11:19AN P2 DATE RECEIVED �... r EHD LOG NUMBER SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Vic 0(0 304 E Weber Ave 3Td Floor Stockton CA 95205 I �� (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca.0M NA AN 10. +08 Std .lu<; PUBLIC RECORDS +'LEAS', APPLICATION, GUr�.!CUU �tdY►ROC(IUNj r rn O k P'A ` APPLICANT: S ee /� Q'M �, �rW BUSINESSIAGENCY: �(�y�rf(I_S s� �(AL-! r►� ^sf *.y rP �T�� ADDRESS: �� v✓ �' +'1 d �, Zee— ?—P& '�v yg - PHONE: �G a� FACSIMILE: EC� -0�`� TENTAI (VE• APPOINTMENT DATE: %��//�,� TImo: (Please allow 10 busin©ss days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE —REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT, _DATE nepartment Use Only �J F• hh � _r_ W".r I H UNIT ENVIRONMENTAL HEALTH DEPARTMENT FILES 0 Unit 1 CJ Unit 2 Unit 3 Unit 4 E] Unit 5 X UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY OTHER CLEANUP SfTE (NON•LOP) 0 FOOD FACILITY o SOLID WASTE VEHICLE UNDERGROUND TANK (MON ITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY >(HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT Q TIERED PERMITTED FACILITY 13 MOTI_UHOTEL L1 PUMPER TRUCK/YARDICHEM TOILETS M TATTOOISODY PIERCING 0 POOUSPA ❑ LAND USE APPLICATION SITES I-) MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFIC 1. List up to ten addresses in the space above. Select the type(S) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days: but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be Immt:diately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same Condition as released will be reorganized by EHD staff at the expens3 of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. "TENTATIVE appointment dates must ba confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT GATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED - YES NO REVIEW DATE EMP 4802400 8/6/2001 A FILE ADDRESS I. CR 2. Street G 3. shat city 4. street city s. StreOt d. fi. Streei 7. street CRY e. 61,00 9. 10, Strict Street Gt City_ ENVIRONMENTAL HEALTH DEPARTMENT FILES 0 Unit 1 CJ Unit 2 Unit 3 Unit 4 E] Unit 5 X UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY OTHER CLEANUP SfTE (NON•LOP) 0 FOOD FACILITY o SOLID WASTE VEHICLE UNDERGROUND TANK (MON ITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY >(HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT Q TIERED PERMITTED FACILITY 13 MOTI_UHOTEL L1 PUMPER TRUCK/YARDICHEM TOILETS M TATTOOISODY PIERCING 0 POOUSPA ❑ LAND USE APPLICATION SITES I-) MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFIC 1. List up to ten addresses in the space above. Select the type(S) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days: but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be Immt:diately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same Condition as released will be reorganized by EHD staff at the expens3 of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. "TENTATIVE appointment dates must ba confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT GATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED - YES NO REVIEW DATE EMP 4802400 8/6/2001 A