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4 <br /> FRO <br /> Geo-Phase Env i rontmen to t n c. FAX NO. : '2095690295 - <br /> 17ec. 24 2004 12:19PM P2 <br /> - 1ErHD�LOG NUMBER <br /> ° 61V.E -SAN JOAQUIN COUNTY <br /> X 00 4 EN WRONNIENTAL HEALTH D <br /> DEC 304 E Weber Ave Std Floor Stockt A <br /> -3420 Fax: (209)464-4138 V'Vela;www.co.sk%-joaquin,ca.Wehd <br /> JjS PUBLIC RECORDS RELEASE APPLICATION { <br /> APPLICANT: .�+ BUSINESS1AGENCY: <br /> ADDRESS; !J ! A <br /> i <br /> PHONE:, ��i �a� 3 FACSIMILE:_ - <br /> TENTATIVE*APPOINTMENT DATE:�. �,l� Time: <br /> 10 business f fmin date of application submitta <br /> (PietiSs allow days pp n <br /> ACHECK Box TO EXPEDITE REQUEST-S93.00 I±EE-REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> 93 <br /> SIGNATURE OF AE PLJCANT DATE AfMI <br /> OMy 1 <br /> PILE ADDRESS <br /> UNIT <br /> 1, Unit'I <br /> S fr /Icw22 <br /> a Sweet ® o /• sa -l�' > Unit 2 l/N <br /> S. Reg " 1••lnit 3 y <br /> 9. succi " /-Jo <br /> ryJ`r , <br /> 7. sweet to a. Unit 4 <br /> a weal - <br /> +o. •� fir'-`�• <br /> U Unit 5 ' <br /> 9- svea <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> YUNDERGROUND TANK(UST)CI-EANUP srM(LOP) ❑ HOUSING ABATEMENT ❑ SOLIDWAS f >< <br /> Cl OTHER CLEANUP SME(NON4_0F) 13FOOD FACILITY I7 SOLID WAS 1.,17 LE <br /> 0 UNDERGROUND"LANK(MONITORINWREMOVAL) © DOG KENNEL R DAIRY <br /> 11 HAZARDOUS WASTE OFNERATOR M CHICKEN RANCH © PKG TREAT �PLANT <br /> 6 YIERED PERMITTED FACILITY ❑ MOTEL/HOTEI- ❑ PUMPERTHucKrtARD/CH5M TOILETS <br /> M TATTOO/BODY PIERCMG,y ❑ POOLtSPA, Ci LAND USE APPLICATION WES <br /> ❑ MEt]1CAL WASTE FACILITY 11 OTH>*R(PLEASE SPECII <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 09 464.0138 or mail to the <br /> address Indicated above. ' <br /> 2. EHD will notify the applicant if any EHD files exisL An appointment for review will be confirmed <br /> approximately five buslness.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 APP01 T.-HENT.DATE TIMI± <br /> DATE CONFIRMED <br /> PHgNE FAX'' INITIAIS'' _ <br /> REVIEWED YES NO PrEVIE,W DATE <br /> �o as-ox-ooc <br /> tuanocs - <br /> 1 <br />