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FROM = Geo-Phase Envircnmentle�inc. FRX NO. : 2055690295 Jan. 27 2005 09:47AM P2 <br /> _ �= <br /> UA1t AtUIYtU `�I EHD I�OG NUMBER , <br /> RECOVED SAN JOENV ONMEN AL HEALTH DIVISION <br /> COUNTYPUBLIC HEALTH VICES � I <br /> 304 EAST WttBe12-A---V-EHUt,T1HRp FLOOR <br /> 9. 7 ?(105 STOCKTON CA 95202 <br /> (209) A68.3420 <br /> Ersvi ol�fvt r+ HEALTH (209) <br /> RECORDS RELEASE APPLICATION <br /> APPLICANY -k;44BUSINESSjAGENCY�15ZeV <br /> AbDRESS <br /> PHONE FAdSIMILE I 0 <br /> TENTATIVE*.APPOINTMENT DATE_„ / G_- TIME <br /> (please give 7 to 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-R QUEST PROCESSED INS SINESS DAYS; <br /> SIGNATURE OF APPLICANT DATE ` G <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAMA ELEMENTS SEARCH <br /> kit <br /> ff10L v t <br /> Lir mL— . ;sG, <br /> de- <br /> b .ter <br /> U� <br /> T tNvlRtIMENTAL HEALTH DIVISION FILES <br /> { UNDERGROUND YANK(USI)CLEAN P SITE(LOP) O HOUSING ABATEMENT d SOLtt].WASTE FACILITY <br /> OTHER CLEANUP SITE(1q00-OP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITOPINGIREMOVAL) Q DOG KENNEL ' ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEWRANCH {3 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELMOTEL 0 PUMPER TRUCK1YARDTCH9M'tOILETS <br /> 17 TATI"0019ODY PEIRCING to POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 I r-DtCAL WASTE FACILITY 5 U PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above, saiecYthe types) of files from the list above by checkin{ <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)_464-0138 or mai[to the <br /> address indicated above. <br /> Z. EHD'wil(notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> 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 avail tile. <br /> 4. Any file not returned ifi 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 /> S. *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 HATE. TIME <br /> DATE CONFIRMED PHON FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> •s oi•nnr <br />