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FROM_ : Geo-Phase Environmen*ine. FRX NO. : 2095690295 • Jan. 27 2005 09:47AN P2 <br /> UAIE IRCEIVED EHDI,OG NUM5ER <br /> SAN JOAQUIN COUNTYPUBLIC <br /> VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> ',' 19 7 71105 STOCKTON CA 95202 <br /> ENVInONMcNT HEALTH (209)468.3420 <br /> PUBLIC REECORDS RELEASE APPLICATION <br /> APPLICANYlanj /'r/ BUSINESSIAGENCY ��V <br /> ADDRESS 0�7-- .4" !; nardN �dG <br /> PHONE W 6PA q FACSIMILE 6®/ <br /> TENTATIVE''.APPOINTMENT DATE �.�C TIME <br /> (Please give 7 to 10 business days from date of application submlual)IZA <br /> CHECK BOX TO EXPEDITE REQUEST $89.00 FEE-R QUEST PROCESSED IN 3,�USINESS DAYS; ' <br /> SIGNATURE OF APPLICANT I/ DATE / v' <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> drn <br /> d .19 <br /> -a <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> UNDERGROUND YANK(UST)CLEAN-UP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(1,10N10P) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRuCK/YARP/CHEM TOILETS <br /> 0 TATTOO/DODY PEIRCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 5 ElPUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVE) <br /> 1. List up to ton addresses in the space above. Select the type($)of files from the list above by checkinl <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. 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 /> 3. A file that.is actively being worked on by EHD staff may not be immediately available for review. A no <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 expens <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to revie <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 APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE __ "' <br />