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—=-Fk M Geo-Phase Environmental Ir FAX NO . 2095690295 v . 12 2003 04 : 56PM P2 <br /> I DATE RECEIVED - EHD LOG NUMBER <br /> � 'E r \ It 11V\// SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT / <br /> NOV 1 Q 304E Weber Ave 3rd Floor Stockton, CA 95205 'A <br /> 468-3420 Fax: (209) 464-0138 Web : www,co.san-joaquin.ca.us/ehd x/ <br /> HW1R (jNMENI HEAL111 I AAA <br /> PERMIT/SSEEERRVICIH / PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -l/�f�� ham "! ✓t BUSINESSIAGENCY: <br /> d2g3 � 1/� >.�•s, p t AdG Ploey <br /> ADDRESS: d& j / <br /> r�yf' p p <br /> PHONE: FACSIMILE: <br /> TENTATIVE` APPOINTMENT DATE: TUEr ef"" Time: N I I <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /`"r DATE �� 6 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> sree 3 � A: G ? re illi o V <br /> z. sl�a ® S. ro a G N ❑ Unit 1 <br /> 3. sveel / U <br /> 9 . Sirael y� 1^ Gl ❑ Unit 2 <br /> 5. SIIne� J CI �3 45 a a�/ <br /> 6. 3Veet cily <br /> >. sveet City Unit <br /> S. Svcot Dry <br /> s. so-eel <br /> UW Unit 5 <br /> 10. svccl City <br /> f <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ` f <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLA14T <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING ❑ PGOLISPA ❑ LAND USE APPLICATION SMS <br /> 0 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 above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 4644136 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 /> 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 /> f&'acT• <br /> CONFIRMED APPOINTMENT DATE . • . . . . . <br /> TIME <br /> DATE CONFIRMED PHONE FAX INITIALS ' <br /> I <br /> 1 REVIEWED YES NO REVIEW DATE <br /> EHD 4042496 <br /> I BIA/1001 - ' <br />