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Geo -Phase Environmental r FAX NO. 2095690295 w. 12 2003 04:56PM P2 \ DATE RECEIVED EHD LOG NUMBER SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT N 0 V 12 2QQQ 304 E Weber Ave 3rd Floor Stockton, CA 95205 (2v9 468-3420 Fac: (209) 464-0138 Web: www.co.san joaquin.ca.us/ehd FNVIRONMEN I HLAL1 , PERMIT/SSE�ER��VICES// PUBLIC RECORDS RELEASE APPLICATION APPLICANT: J 'r/ xa' '- BUSINESS/AGENCY: rQ4 aSG ADDRESS: r1 `7 p��P'lftr/i►sQ'+t Ar/G �D�P t7� PHONE: _ 7�� O� / 3 FACSIMILE:.. 4W.91 TENTATIVE' APPOINTMENT DATE:-_reye- / X-^ Time: ^rT,J11, (Please allow 10 business days from date of application submittal) �--µ _" t ti v v 1 J J'1;, CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT_DATE �� 6 Department Use Only UNIT ❑ Unit 1 ❑ Unit 2 •.1� G�1 �J Unit Unit 4 ❑ Unit 5 ENVIRONMENTAL HEALTH DEPARTMENT FILES► UNDERGROUND TANK (UST) CLEANUP SITE (LOP) d HOUSING ABATEMENT ❑ SOLID WASTE FIL}iY,,,% OTHER CLEANUP SITE (NON -LOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE z UNDERGROUND TANK (MONITORING/REMOVAL) 0 DOG KENNEL 13 DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT El TIERED PERMITTED FACILITY 13 MOTVUHOTEL El PUMPER TRUCKIYARD/CHEM TOILETS O TATTOO/BODY PIERCING 17 POOL/SPA 0 LAND USE APPLICATION Sn_ES ❑ MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) 1. List up to t©n 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 immediately 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 expense 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 DATE TIME a �• DATE CONFIRMED PHONE FAX INITIALS, REVIEWED YES NO REVIEW DATE FILE. ADDRESS I. Street Sep G ct - v' 4 -,Y. i. Street ® S -n ' � C. 3. street 4. Street Q h v v Ci s. $traet 7 � � t►N ti a 6. street City 7. Street City 8.Strcet 9. Street HE 10. SVCct GN UNIT ❑ Unit 1 ❑ Unit 2 •.1� G�1 �J Unit Unit 4 ❑ Unit 5 ENVIRONMENTAL HEALTH DEPARTMENT FILES► UNDERGROUND TANK (UST) CLEANUP SITE (LOP) d HOUSING ABATEMENT ❑ SOLID WASTE FIL}iY,,,% OTHER CLEANUP SITE (NON -LOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE z UNDERGROUND TANK (MONITORING/REMOVAL) 0 DOG KENNEL 13 DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT El TIERED PERMITTED FACILITY 13 MOTVUHOTEL El PUMPER TRUCKIYARD/CHEM TOILETS O TATTOO/BODY PIERCING 17 POOL/SPA 0 LAND USE APPLICATION Sn_ES ❑ MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) 1. List up to t©n 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 immediately 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 expense 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 DATE TIME a �• DATE CONFIRMED PHONE FAX INITIALS, REVIEWED YES NO REVIEW DATE