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Geo Phase Envirormenta,,, nc. FAX NO. 2095690295 ,w Jul. 26 2004 04:34PM P2 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> HE(N1EPI VE© ENVIRONMENTAL HEALTH DEPARTMENT <br /> II 11 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> JUL 2 6 20009)468-3420 Fax- (209)464-0138 Web:w*v.co.san-joaquin.ca.us/chd mil <br /> ENVIRONMENT PUBLIC RECORDS RELEASE APPLICATION <br /> P ' 1� ^ <br /> APPLICAN7Ryr/ rof BA�USI��NESSIAGENCY: d IOJ� !rk,r�71r2�• -+.. ►« 7t'/ <br /> ADDRESS:i <br /> PHONE: �,'� �eZQ•� FACSIIMIILE:, X69 did�!� <br /> TENTATIVE'APPOINTMENT DATE: ' H/• 7��.(J Time: <br /> (Please allow 10 business days from date of application submittal) <br /> ✓�-+ '6Y1 ECK BOX TO EXPEDITE REQUEST-$93.00 FEE <br /> -REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DATE 7 G <br /> Deparfment Use OMy <br /> FILE ADDRESS UNIT <br /> ,. suca`��S4• " a ❑ Unit 1 <br /> z. 50- <br /> Unit 2 ��l <br /> a. $Vee <br /> s. s�I °• Unit 3 ,2l\ <br /> 6. Street Cdy <br /> d i <br /> 7, so- o• UnR4 <br /> 6. $rteM <br /> 9. Shael ❑ Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �UNorRGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> Jq OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) D DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 17 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOOIBODY PIERCING 0 POOI.ISPA M LAND USE APPLICATION SITES <br /> CI MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <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 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 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. `TEN7ATNE 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 APROINTNIEiNT..DATE ... TIME. <br /> DATE CONFiRMED: PHQNE . FAX''. .: - INITIALS <br /> REVIEWED - YES NO REVIEW DATE <br /> o�6azaaa _—^- <br /> vart000 <br />