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FROM : Geo-Phase Environmenta.�ic. FAX NO. 2095690295 � Jul. 26 2004 04:34PM P2 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> G L L�I17' ENVIRONMENTAL HEALTII DEPARTMENT <br /> LSI :2 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> JUL 2 6 200q 09)468-3420 Fax: (209)464-0139 Web:www.co.san-joaquin.ca.w/ehd lq2l <br /> ENVIRONMEN S PUBLIC RECORDS RELEASE APPLICATION <br /> AP/PlLlICATIO�N <br /> PER111 17SERVI <br /> APPLICANT; 49"er / BUSINESSIAGENCY <br /> r7s-� n,t. .w ar� <br /> ADDRESS: j9 997 eg FiredM <br /> PHONE: �'� g�402_q0) <br /> FACSIMILE: a -' <br /> TENTATIVE*APPOINTMENT DATE:�i N 1 7,L'{�O Time: o / <br /> / (Please allow 10 business days from date of application submittal) <br /> w '6t1ECK SOXTO EXPEDITE REQUEST-$03.00 FEE <br /> -REQUEST PROCESSED IN 3 BUSINES D_ AYS <br /> SIGNATURE OF APPLICANT �d"r DATE 7 G G <br /> Depar4ent Use Only <br /> FILE ADDRESS UNIT <br /> et.e.3&SG l a ❑ unit 1 <br /> z. 6tes oo / <br /> City <br /> ?3 CorM iY z, G A' <br /> �. st.ei cUnit <br /> a. steer <br /> s, s,�l City nit 3 /\ <br /> 6. Street C � , <br /> 7. SkM p Unit 4 <br /> 8. 6nm! G <br /> S. steal r. ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES @s r <br /> ,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> JK OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) D DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR LI CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILrrY 0 MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> D TATTOO/BODY PIERCING D POOLISPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list aboye 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 riles <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 /> S. 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 /> 6/BReo7 <br />