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FROM Geo—Phase Environmental FAX NO. : 2095690295 -eb. 17 2006 05:38PM P2 <br /> DATE RE'GEIVED . EHD LOG NUMBER <br /> = SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209),468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.US/ehd <br /> prQi�'�Ss(l� ivf 1 <br /> PUBLIC RECORDS RELEASE APPLICATION 5000, <br /> APPLICANT: S? C� d {a14BUSINESS/AGENCY. �C���1 trs�° —+c a�rry�► ^~s <br /> ADDRESS: 7 ex f4,.,A &Y%4 Ari <br /> PHONE: i (J�.� FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: is Time: . <br /> 5 <br /> (Pieaso allow 10 business days from date of application submittal) m <br /> �6HECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUES f PROCESS)=A 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 2. srreet r /del ❑ Unit 1 <br /> s. sveec 64 CAIL <br /> 4. 2 <br /> a. Street aty <br /> s_ s <br /> ON 3 <br /> a. Street <br /> aty <br /> ). S•aeet r. <br /> "'tlY All <br /> Unit 4 <br /> e. Street [j Unit 5 <br /> 10. sl eet <br /> We— Am <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT Ll SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 4 FOOD FACILITY d SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) d DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELMOTEL O PUMPER TRUCKfYARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING ❑ POOL/SPA O LAND USE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <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 (2091464-0138 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 new <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 expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <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 DATE TIME <br /> DATE CONFIRMED PHONE FAX' INITIALS <br /> REVIEWED YES 'NO :REVIEW DATE . <br /> END 48.024D6 <br /> &W2003 <br />