Laserfiche WebLink
FROM : Geo -Phase ErvironmentalAbac. FAX NO. 2095690295 Dec. 12 2000 04:11PI,I P2 <br />-� �;tw tUC MUAitlEH <br />V®AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />UU uu 344 EAST WEBER AVENUE, THIRD FLOOR 041 <br />DEC 1 2000 STOCKTON CA 95202 <br />(203) 468-3420 <br />ENV�R .T ELIC RECORDS RELEASE APPLICATION <br />N <br />62-4— BilslNEssrAGENCY, C�+�`�"y +#`1ls e- .��rd�' ^e�'y!'�'++ "74+ — <br />APPLI <br />ADDRESS � � �"� �' � '°f <br />FACSIMILE <br />PHONE �° 5 <br />TF-MTATIVF-- APPOINTMENT DATE of apTIME <br />(please give 7 to 10 business days from date pfication submittal) <br />ZK CHECK BOX TO EXPEDITE REQUEST . $78.00 FEE - <br />SIGNATURE OF APPLICAN <br />PROCESSED IN 3 DUSIN ESS DAYS <br />DATE <br />ENVIRONMENTAL HEALTH nlvtslvna rtic� <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT to SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON-LOPj <br />C1 POOD FACILITY ❑ SOLID WASTE VEHICLE <br />II ®OG K)rNNEL C3 DAIRY@, tl1�IUERGROUiJD TANK (M4N[TORINGlRi:6QOVAt) ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br />[!• HAZARDOUS WASTE GENF-RATOR p MOTeUIiOTEL 13 PUMPER TRUCKJYARDICH>rM TOILETS <br />13 TIERED PERNSITfED FACILITY Cl POOLISPA ❑ LAND USE APPLICATION SITES <br />n TATTOOIEODY PF-IRCI14G p PUBLIC WATER SYSTEM © OTHER (PLEASE SPECIFY ABOVE) <br />0 MEDICAL WASTE FACILITY <br />1 _ List up to ten addresses in the space above. Select the type(s) of Tiles from the fist above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to L209 464-0138 or mail to the <br />address indicated above. <br />?, 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 />g. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <br />application may be submitted when the file is available. <br />4. Any file not returned in the same c: ncllilon 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 />6. Applications received after 3:44 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED _ PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE _ <br />