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r , <br /> __--FROM Geo-Phase Environmenta C. FAX NO. 2095690295 [ Jun. 24 2004 04:14PM P2 <br /> , ••� �-C EHD LOG NUMBER <br /> { �� I IUEq; ; - }; SAN JOAQUIN CoUN'TY <br /> ,F <br /> ENVIRONMENTAL HEALTH DEtPARTMENT <br /> r .SUN 2 4 2004 304 H Weber Ave 3 Floor Stockton.1-CA 95205 <br /> 2i)9- 468-3420 Fax: (209)464-0138 Web.www.co.san joaquin.ca.us/ehd <br /> ENViRONiI rIENT i LAL�Fi jI <br /> PERN,11T/SERViCES PUBLIC RECORDS RELEASE A PL CATION <br /> a <br /> APPLICANT' BUSINESSIAGENCY: <br /> ADDRESS: 5�3,7 Iley e Aw.4 k /�e e-, <br /> { PHONE: / �0�+ t?:3 FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> i <br /> CHECK 13OX TO EXPEDITE REQUEST-$93.00 EFF-REQUEST PROCESSED I BUSINESS I}AYS <br /> ` SIGNATURE OF APPLICANT DATE <br /> !1 Department Use Only <br /> FILE ADDRESSII , IT <br /> ,. strgg, ed aZ • % d <br /> G d d It Unit 1 � <br /> s. street 7 _.,lit 2 <br /> Sit fir '• 4 : <br /> 5. Street Unit 3 <br /> s, street - Il •i <br /> r. Simi o Unif <br /> 81 streal cityI i <br /> 9. Unit 5 <br /> i. <br /> a rP c / r e M�y I 200 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT I� �SOLIb WANE^�ACII '� <br /> .� THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY } 0 SOLID W '_)t.Vh-iC1.E <br /> NpERGROUND TANK(MONITORINGIR�CMOVAL) CIDOG KENNEL !I] DAIRY <br /> (a HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH '❑ PKG TREATMENT PLOT . <br /> ❑ TIERED PERMITTED FACILITY ❑ MQTEUROTEL ;I '❑ PUM PER TRUCKIYARDICHEM TOILETS <br /> 10 TATTOOIRODY PIERCING ❑ POOLISPA 1i 10 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types)off les 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. EHE)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).flays 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. l <br /> 3. A file that is actively being worked on by EHD staff may notiiae immediately available for review. A new <br /> application may be submitted when the file is available. 11 <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 reI. <br /> quire a$93.00 deposit priorto review. <br /> 5. *TENTATIVE appointment dates trust ba confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business da <br /> ` U, v <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED __ •PHONE FAX': INITIALS <br /> II <br /> REVIEWED YES NO REVIEW DATE! <br /> END 4t MDG <br /> 9f;s+YOad �' <br /> i <br />