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tom, <br /> FROM : Geo—Phase Environmenta ,�,ic. FAX NO. : 2095690295 Apr. 21 2005 10:42AM P2 <br /> (� EHD LOG NUMBER <br /> p � J�V�I�1=-) SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT -7 36 <br /> APR 9, 1 9nQS304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> ENVIRONMENTR; 1?168-3420 <br /> 8 3420 Far: (209)464-0138 Web:www.co.san-joaquin,ca.us/ehd <br /> PE_RIUIT/SE,9VICH-S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_�f�'s/� 44ty�/`�~� BU <br /> SINESS/AGENCY: <br /> ADDRESS: ��►7Je <br /> 6 <br /> PHONE: f , FACSIMILE:_ ©� <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDrrE REQUEST-593.00 FEE--REQUEST PROC>SSE 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> ,, str ❑ Unit 1 <br /> s. sucot G G ❑ Unit 2 �•2 <br /> City <br /> s. $Deet bUn <br /> rstreet a <br /> 9. strec+ <br /> B. .Street CGt ❑ Unit 5 <br /> ty <br /> 10. Strw G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES FACT <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WAS <br /> TE E?US f' <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 11 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) M DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH M PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY M MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING [APOOL/SPA LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1 List up W ten addresses in the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)At�4-0138 or mai!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. Anew <br /> application may be submitted when the file is available. <br /> a. Any file not returned in the same condition as released will be reorganized by END 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 /> 5• 'TENTATIVE appointment dates must be confirmed with FHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business da <br /> ,s <br /> TIME <br /> CONFIRMED APPOINTMENT DATE <br /> - ::.PHONE FAX - INITIALS <br /> DATE CONFIRMED <br /> REVIEWED YES NO REVIEW DATE <br /> EHD aE-02-000 <br /> emn_, <br />