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FROM Geo-Phase En,ironment Inc. FAX NO. : 2095690295 <br /> ` '� Jan. 27 2005 09:47AM P2 <br /> Wk aeceivea / <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ENO 1,OGNUMflEA <br /> v -ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOh <br /> 1 2 7 9no5 STOCKTON CA 95202 <br /> Et-WiRONMcNT HEALTH (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANY Pr BUSINESSIAGENCY-C-- <br /> ADDRESS ?2 /&p M <br /> PHONE_ ����a7,q 3 FACSIMILE„ ag 0 ^' <br /> TENTATIVE*-APPOINTMENT DATE �e TIME �"`-:•r <br /> (Please give 7 to 10 business days from date of application submittal) }. <br /> s <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-R QUEST PROCESSED IN 3 SINES$DAYS_ <br /> SIGNATURE OF APPLICANT DATE / G <br /> rr .Ili Y�MUI®YI <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> . 40 Grp -we7. SxT _ Aj4—SUI <br /> d rn:_ <br /> c} a <br /> r. t`t <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �( UNDERGROUND TANK(US' 'CLEfik JP SITE(LOP) p HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> I�OTHER CLEANUP SITE(NQNLLOP) © FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Q;(UNDERGROUND TANK(MONIYORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY CI MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOMODY PEIRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY r p PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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 209 464-0938 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 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 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 DATI< �"' <br />