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FROM : Geo-Phase Environment-' lInc. FAX NO. 2095690295 Jan. 27 2005 09:47AM P2 <br /> Qk <br /> UAIt NL•CUVED ERD%OG NUMBER <br /> RECENED SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> V ENVIRONMENTAL. HEALTH DIVISION <br /> 304 EAST WEBEFt AVENUE THIRta FLOOR <br /> "_" _, <br /> 11 7 7005 STOCKTON CA 95202 <br /> (2Q9).068.3420 <br /> •EEJVInONMGNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT . T` BUSINESSIAGENCY .ECJ <br /> ADDRESS pw�"7G <br /> PHONE- -- �q ®e7, 3 _ FAdSIMILE <br /> TENTATIVE'-APPOINTMENT DATE _ G _ „ TIME . <br /> (Please glue 7 to IQ business days kvM datd of application submittal) =•-" '; <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE--R QUEST PROCESSED IN 3 SINESS DAYS, <br /> SIGNATURE OF APPLICANT DATE <br /> k <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY I <br /> PROGRAM ELEMENTS SEARCH <br /> i'Il— <br /> MN iL , <br /> ,ENVIR04'MENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(US'f} LE�SITE(LOP) 0 HOUSING ABATEMENT 0 SOLI]WASTE FACILITY. <br /> OTHER CLEANUP SITE(NOni=op) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KEN14F-L ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT . <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICH>M 701LETS <br /> ❑ TATTOOMODY PEIRCING a PDOLISPA 0 LAND USE APPLICATION SITES <br /> 1;3 mrt)ICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 13 OTHER(PLEASE SPECIFYABOVE) <br /> • E� <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 209 464-0138 or mail to the <br /> address Indicated above. <br /> 2'. EHD"wlli 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 beim#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 rcturned iti 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 rovie <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 /> CONI~IRMED APPOINTMENT DATE. TIME <br /> DATE CONFITZMED - PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE. <br /> �d <br />