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i <br /> FROM Geo-Phase Environment Inc . FRX N0 , 2095690295 Nov. 12 2003 04 : 56PM P2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> IPI , \�, 7Lr ENVIRONMENTAL HEALTH DEPARTMENT J <br /> NOV 12 QQ 304 E Weber Ave 3r1 Floor Stockton, CA 95205 <br /> vJ 468-3420 Fax : (209) 464-0138 Web : www'CO 'San-joaquin.ca.us/efid <br /> FNVIRONMEM HEAL111 I <br /> PFRMITISS [ R�VICFS / PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -�/�'f�P� /'& "1 r BU♦SINESSIAGENCY: 1444gsG- .rl{!� /�'b+ye �. <br /> ADDRESS: a.q' 3 7 (�P. 'NPr�1 + A'M rA�G / /o060 jr ?V <br /> PHONE: JVD 0 93 FACSIMILE: 41r1 d,2 <br /> TENTATIVE' APPOINTMENTDATE: . TU2. s-- Time: <br /> ^ I, (Please allow 10 business days from date of appllcatlon submittal) <br /> A/�( CHECK BOX TO EXPEDITE REQUEST • $93.00 F/EE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1 ��� DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> sveet 3 � G a iter* 44 city Sr ❑ <br /> Unit 1 <br /> 3. street Gr 71e✓ GY <br /> c � ❑ Unit 2 <br /> 4. alreel Q F` le' m <br /> 5. Cvnai h v4 CI a V <br /> 6. SVeet City <br /> T. street CIN Unit <br /> 8. Sirrot c4ty <br /> 9. street Cit ❑ Unit 5 <br /> ,0. Svcs <br /> Cly <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r .7 <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) Cl HOUSING ABATEMENT 171 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH CI PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY C3 MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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) 4644138 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 /> CONFIRMED APPOINTMENT DATE <br /> TIME . . . . <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED _ YES NO REVIEW DATE <br /> EHD 18-01-000 <br /> eMI10a] - <br />