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FROM.: Geo--Phase i Envi ronmental IQ # F»X NO. 2095690295 `n. 18 21703 04:2'.iPl l P <br /> kw� <br /> SAN JOAQUIN COUNTY?UBLIC HEALTH SERVICES `r <br /> ENVIRONMENTAL WEALTH D1ViSION <br /> 304 EAST WEBER iWENUE,THIRD FLOOR <br /> JUN $ 200YSTOCKTON CA 93202 ° <br /> (209146&3420 <br /> PUBLIC RrECORDS RELEASE APPLICAT)ON � <br /> Fi P�ALi�TA1�'r R�'ir C DY'Gi 8USINE351AGENCY_C?,,�0,, !!� 54- <br /> AIJDRESS 17 Y/,PVZAw 14 - ---- -- - _� <br /> PHONE 56F pR 1=AcslMll r 'S—GJ 4.29 <br /> TF-NTtATIVE"APPOINT,yICNTDATE � TIME <br /> (Please pivc 7 to 10 business days from dltC of application Submitt:,l) � m <br /> • ! �� <br /> CHECK 80X r0, XPEDiTE REQUEST-$f37.00 FEE—REQUeST PROCES5EQ IN 7 13USINLSS O.,YS <br /> SIGNATURE OF APPLICANT !� �C�^ _ I?!a'IS <br /> FILE ADDRESS THIS SIOU C.HD I;rAFF USE ONLY <br /> PROOF" ELEDIENTS SEARCH <br /> -�� Gd r/L+.r7�'Y �,_ sT� � /�077 /l�oa'Tr•r �L` <br /> Ir <br /> opal <br /> ENVIRONMENTAL HEALTK bIVISION FILES <br /> PQUNDCRGROUND TANK(UST)CLEANUP SITE,JLOF) 0 HOUSING ABATEMENT C3 SCIJE)wA:;TE FACILITY <br /> Q OTHER CLEANbP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SCILID WA:ETE VEHICLE <br /> tL UNDERGROUNQ TANK(MONITORINGIREMOVAL) ❑.DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASJ�EE GENERATOR Q CHICKEN RANCH C3 PE.G TREAVOCNT PLANT <br /> 0 TIEREDPERMITT4 FACILITY ❑ MOTEUH'OTEL 0 PV.M1F'GRTRUCIVYARVICHE14TOILETS <br /> ❑ TAi roolaoDY POIRCING ❑ POOLISPA ❑ LPNC U5E APPLICATION SITES <br /> ❑ MFDLC:AL WAsT9 FACILITY 0 PU13LIC WATER SYSTEM O 07:4ER(PLEASE SPECIFYA13OVE) <br /> �. List up to ten addresses in the space above. Select the typc(s)of files frorn tha list above by chachinU <br /> the appropriate boxes). At least one file type MUST be selected. Fax tc!U 09) G)4-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files .Ast. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after mccipt cif application.-The files <br /> will be held fora maximum of five business days for review. Appointmrnis should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHE staff may not be irlimedia telt'iv ailablc fvr revir:w. A new <br /> application may SUbmlttcci whon the file is available. <br /> 4. Any file not returned in the same condition as released will be reorgani.=ocl t3y AHD staff at the expense <br /> or the applicant. Future file reviews by the slime applicant May require a $:BT.I10 deposit prior to review, <br /> 5• *TENTATIVE appointment dates must bo,confirm6d with EHD staff. <br /> 5. Applications received after 3.00 pm will be processed the next business day. <br /> low <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED FAME FAX INITIALS <br /> REVIEWED '� YES NO REVIEW DAT8 - <br />