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FROM : Geo—Phase Environmental I FAX NO. : 2095690295 18 2003 04:21PM P2 <br />SAN JOAQUIN COUNTY?USLIC HEALTH, SERVICE:: 11 <br />!E�� ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />JUN 1 S 2Q03 STOCKTON CA 95202 <br />(209) 468-3420 13 <br />EN ,.: , , „_., _ ., PUBLIC RECORDS RELEASE APPLICATION <br />I'Ap����Tdr�r��, � d / ..... <br />---=!/ e 6.r1,.. G 7^ 8U5INESS/AGENCY �a �H6f <br />ADDRESS G - <br />PHONE 6'4'f ' 'A 9 _5 FACSIMILE <br />TENTATIVE"APPOINTMENT DATETIME <br />Via— give 7 to 10 business days from dotc of application submittal) w <br />CHECK SOX TO EXPEDITE REQUEST • $07.00 FEE - REQUEST PROCESSED IN 3 BUSINCSS <br />SIGNATURE OF APPLICANT _� /� C�� ` D�;( E <br />\N <br />..-IAFF USE ONLY <br />r . n rTJr�l,, <br />y <br />Il - <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />QQUNOERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING A13ATEMENT C3 SOLID WASTE FACILITY <br />O OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY ❑ SOLID WX;TE VEHICLC <br />94 UNDERGROUND TANK (MONITORING/REMOVAL) O DOG KENNEL O DAIRY <br />O HAZARDOUS WASTE GENERATOR O CHICKCN RANCH O PKG TREAI'MENT PLANT <br />❑ TIERED PERMITTED FACILITY CI MOTELfHOTEL O PUMPER TaUCIVYARVICHE14TOILETS <br />Q TATTOOIBODY PSIRCING O POOLISPA " ' © UNC USE APPLICATION SITES <br />0 MEDICAL WASTE' FACILITY C7 PUBLIC WATER SYSTEM O OT;.4rR (P,.EAsE SPC(:iFYA130VE) <br />1. List up to ten addresses in the space above. Select the types) of files from the list above by checking <br />the appropriate box(es). At least one file type: MUST be selected. Fax to (209) 4G4-0138 or mail to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files mist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after recOpt cif application. The fifes <br />will be held for a maximum of five business days for review. Appointmants should be scheduled <br />accordingly. <br />3. A file that is actively being worked on by EHG staff may not be immediately availal3tc for review. A new <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition ase released will be rcorgani::ed by-- D staff at the expense <br />Of the applicant. Future file reviews by the same applicant may require a 4"87.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHQ staff. <br />6. Applications received after 3:00 pm will be processed the next bus;ness day. <br />M <br />CONFIRMED APPOINTMENT DATETIME 11 To N <br />_. <br />DATE CONFIRMED P-IONE FAX <br />INITIALS <br />RE.VI , � YES <br />RE . NO REVIEW DATE <br />