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f ' <br /> FR Geo-•Phase Ewironmenta''—'nc. FAX No. : 2095690295 <br /> ' t Dec. 24 2oe4!�12:19PM P2 <br /> EHh LOG NUMBER <br /> SAN JOAQU.1N COUNTY <br /> ENVIRONMENTAL <br /> ALr <br /> ryry0Q <br /> 4 ra <br /> ��� � L 304 E 1lVeber Ave 3 Fi00T�l:oGkt <br /> It <br /> #) $-3420 Fax: (249}4G4-0138�Veb:www.co.sail loagtxin,ca.us/ehd <br /> t $ <br /> AS <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Bt1SlNESS1AGENCY: , COCl _ '�IC�' �yCL� - '1 <br /> ADDRESS: !/ QI oo2^-,P <br /> PHONE• ��+/ FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE:_ � /� �_ _ _Time: <br /> 90 buslness from date of kAtlon submina <br /> (PleBbe aElt)Vv days PR <br /> 1. <br /> CHECK BOXTO,EXPEQITE REQUEST-$93.00 PEE-REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> f' <br /> SIGNATURE OF APPUGANT /� DATI= <br /> - Jse Orriy <br /> .i PILE ADDRESS UNIT (r�� <br /> t, aw S42 ❑ `Unit 1 vi <br /> 2. stet /� rr I•' � <br /> a sweet ci // 5a -415, ? :Unit 2 <br /> ♦. 50- ' <br /> s. street j!Unit 3 <br /> B. S1rt Nk e <br /> �. satUnit 4 <br /> : <br /> S. Street TZ 9 <br /> 9. Streel t UnK S <br /> ENVIRONMENTAL HEALTH OF-PARTMENT FILES <br /> UNDERGROUND WANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ARATEMENT 0 SOLID WAS I <br /> CI OTHER CLEANUP SITE(NON-I-OP) ❑ FOOD FACILITY 13 SOLID WA$T <br /> Af UNDERGROUND TANK(moNITORINGIREMOVAL) 13 DOG KENNEL M DAIRY <br /> El HAZAROGUS WASTE GENERATOR A CHICKEN RANCH EI PKG TREATM PLANT:. <br /> b 'TIERED PERMITTED FACILITY IJ MOTELIHOTEL 17 PUMPER TRUCK[YARDICHEM TOILETS <br /> M TATTO01BODY PIERCING CI POOLISPA i? LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY G OTHER(PLEASE SPECIFI!) <br /> k <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list aboye by checking <br /> E the appropriate box(es). At least one file type MUST be selected. Fax to 09 464-0138 or-mall to the <br /> addressrtdi eted above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment fol'review Will be Confirmed <br /> approximately five business days but no later than tett(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 EMD 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 FHD staff atthe expense <br /> of the applicant. Future file reviews by the same applicant may require a.$93.00 deposit prior to review. <br /> 6. *TENTATIVE appointment dates must:be confirmed with EF-ID staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPoiNTMENT,DATi : • ` •' ; <br /> TIME <br /> DATE CONFIRMED PHONE FAX lN1TIALS' <br /> REVIEWED z- YES NOREVIEW DATE <br /> 8M121i0i <br />