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FROM : Geo-Phase Environmenta�. FAX NO. : 2095690295 Dec. 12 2000 04:11PM P2 <br /> 1;9e LOC NUMUER <br /> POEN IRONSERVICES <br /> MENTAL HEALTH DIVISION <br /> DEC 1 2 20 304 EAST WEBER AVENUE,THIRD FLOOR 4 I <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> E U BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Sznde 1 'f`G BUSINESSIAGENCY 6:ew /0lflr.igs- .Evdlr�ro++ �s3z'� <br /> ADDRESSA9S1 [/NMI-"d-4 <br /> PHONE_ Oa!t 3 +L_ FACSIMILE ? <br /> TENTATIVE`APPOINTMENT DATE 1A1TIME <br /> (Please give 7 to 10 business days frem date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-578-00 FEE—R QUEST PROCESSED IN 3 9USINESS RAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> 17aB_ J 0r . <br /> 029.4 ci >�/L <br /> 1 <br /> i <br /> ENVIRONMENTAL HEALTK DIVISION FILES <br /> i� UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> IV OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 13,UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> IS HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MoTEL MOTEL 0 PUMP5R TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOGIEODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> G MEDICAL WASTE FACILITY Im PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVE) <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) 464-0135 or mail to the <br /> addressindicated above <br /> 2. EHO 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 /> 2. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <br /> application may be submitted when the.fi(c 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$78.00 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 01AWD <br />