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FROM Geo-Phase Enyironment�Inc. FAX NO. 2095690295 Jan. 27 2005 09:47AN P2 <br /> DATE IILGHVED \-.i <br /> (o� EHO I�OG kUMbER SAN JOENVI <br /> ENVIRONMENTAL HEALTH DIVISION <br /> RVICI=S <br /> 304 EAST WEBER AVENUE,THIRTY FLOO 2 <br /> 2. 7 9no5 STOCKTON CA 95202 <br /> Ei';VInONMENT HEALTH (209)468.3420 <br /> PUBLIC RE-CORDS RELEASE APPLICATION <br /> APPLICANT 4nf k7445USINESSIAGENCY. <br /> Y r <br /> PHONE ��� ®d7,Q« _ FACSIMILE ©� <br /> TENTATIVE*APPOINTMENT DATE-- TIME ""€_'g <br /> (Please give 7 t010 business days from date of application submittal) <br /> CHECK SOX TO EXPEDITE REQUEST-$89.00 FEE-R QUEST PROCE=SSED IN 3 SINESS DAY$j <br /> SIGNATURE OF APPLICANT DATE / G <br /> :• rr •n YM••11 —�bVl sir <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> rl <br /> Lr m L.- <br /> ENVIP.64i(ENTAL HEALTH DIVISION FILES <br /> rr <br /> UNDERGROUND TANK(UST)CLEANP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON=LOP) ❑ FOOD FACILITY ❑ SOLID WAST:VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Lq'HAZARDOUS WASTE GENERATOR ❑ CHICKEWRANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEL/HOTEL ❑ PUMPER TRuCK/YARDICHEM TOILETS <br /> ❑ TATTOO/60DY PEIRCING Q POOLISPA Q LAND USE APPLICATION SITES <br /> !� mrDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of fifes from the list above by checkint <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 no <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 expens <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to revie <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 /> CONFIRMEDAPPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE �"' <br />