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FROM : Geo—Phase Environrncntai c. FAX NO. : 235�b902S5 hoc. 12 20170 0�1:11Ph1 F'2 <br /> _ i;r�u AUG NUM[fEH <br /> JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> lrll v ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> DEC 1 2 2000 BTocKTON CA 95202 <br /> (209)468-3420 <br /> ENVIR <br /> OBLIC RECORDS RELEASE APPLICATION <br /> APPLI N r C4 BUSINErSSfAGENCY Ged 'llG.f� '���r <br /> ADDRESS <br /> PHONE <br /> PcsZ 3 FACSINULE g 5 <br /> TENTATIVE"APPOINTMENT DATE All 8-- <br /> 8-- TIME <br /> (Please give 7 to 10 business days frorn date of application submittal) <br /> Ez CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—R QUEST PROCESSED INS BUSINESS DAYS <br /> DAVE <br /> SIGNAT URE OF APPLICANT <br /> FILE ADDRESS <br /> 1 .. <br /> • <br /> i <br /> ENVIRONMENTAL HE•4LTK DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 1 <br /> Cl FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) II DOG KENNEL 13 DAIRY <br /> UhDERGROUAID TANK(M4N[TORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 8- HAZARDOUS WASTE GENERATOR p MOTeL/HOTEL 0 PUMPER TRUCK[YARDICHZM TOILETS <br /> 13 TIERED PERMITTED FACILITY 0 FOOUSPA ❑ LAND USE APPLICATION SITES <br /> C1 TATTOOISODY PF-IRCING 12 PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> M MEDICAL WASTE FACILITY <br /> 1_ List up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0135 or mail to the <br /> address indicated above. <br /> ? j=-HD 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. Anew <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 $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> $_ Applications received after 3:00 pm will be processed the next business day. <br /> f CONFIRMED AFP0it4TMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 130 14 OU0510D <br />