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f M Geo-Phase EnOironmental FAX NO.. : 2095690 95 fan. 15 2003 11:53AM P2 <br /> V.f C. l!` �V I IIBLIC H Ai Tl-1 SERVICESSAN JOAQUIN GOUNTYP <br /> i <br /> JAN' l 5 2003. ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,Tir IRD FLOOR <br /> STOCKTON CA 1352(2 <br /> ENVNUNIVIENT HEALTH (209)46"420 <br /> PERfv1IT/SERVICESPUBLIC RECORDS RELEASEAPPLICATION <br /> APPLICANT <br /> I k YIGJ' SUSINESSIAGENCY O Ate <br /> ADDRE55 7 Qvt e <br /> r- <br /> (j FArWmtLr- ' S 3 C <br /> PHONE�.� 0� .__� I - `7-0 <br /> 7>=IH'I'A7lVl="APPOINTMENT DA TE , <br /> TIML• <br /> (Ploase give 7 La 7n bv;itms_days from Ua[a tapplicativn submltWl] • <br /> 1 <br /> BECK 9,OX' o j%XPEDITE REQUEST-$Q7.00 ME-RLQUtST hROCC55[ IN 3 BUSINCSS DAYS <br /> tjn; <br /> BATE <br /> SIGNATURE OF APPLICANT, <br /> THIS SIDE FHC STAFF USE ONLY <br /> FILE ADt7RL5S PI2oGRAM CLLM[NTS SEARCH <br /> �rser ve <br /> 09 rr <br /> S w. 7Lou J <br /> j <br /> a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> a HOUSING AQATE ENT 0 SOLID WASTE FACILITY <br /> UNDLHGFOUNt)TANK{UST)CLEANUP SITE(LOP) 0 FOOD FACILITY 0 SOLID WASTF VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) Q dao KENNEL 0 DAIRY <br /> UNDERGROUNDTANK(MONITORINGIREMOVAL) p.CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> HAZARDOUS WAS GENERATOR C3 CHICKEN RAN Q PUMPERTKUCIVYAI DlGHEMTOILETS <br /> O TIEREE)PEIYMITCI;FACILITY 0 P OTELJ JO 0 LAND USE APPLICATI&• ITVS <br /> G TATTOOIBODY PNIRCING <br /> 0 MEDICAL WA$T4 FACILITY C1 PUBLIC WATER SYSTEM 0 OTHER(PLEASE <br /> SPECIFY A[30VE) <br /> 1. List up to ten addrgssns inl the space above. Select he type:($) of files from the list above by chockincg <br /> the appropriate boX(es). At least one file type MUST be SONG <br /> FaX to 209 4G4-0136 or mail to the <br /> address indicated above. <br /> 2- EHb will notify the applicant if any EHD files exist. appointment far review will be confirmed <br /> approximately five business days but no later than tn('10) days after receipt of application.'Ttte fil <br /> � e$ <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 Iseing worked on by>=HD staff n,ay not be immediately available For review. Anew <br /> application may be submitted when the file is avails Ic- <br /> 4. Any file not returned in the same condition as releas d will be reorganized by EHO staff at the expense <br /> of the applicant. Future file reviews by the same ap licant may require a$87.00 deposit prior to review. <br /> S, *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> �: AppticatiOn$ received after 3:170 pm will be process d the next business day. <br /> �.� <br /> f <br /> U .0 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> k DATE CONFIRMED ,PHONE FAX INITIALS <br /> ! -REVIEWED ► YES NO REVIEW WA'I'F <br />