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FROM Geo-Phase Environmental FAX N0. : 2095690295 Feb. 17 2006 05:38PM P2 <br /> 0 GEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> F _� ; •� ENVIRONMENTAL HEALTH DEPARTMENT <br /> t 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209,)• 68-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/e <br /> hd <br /> PUBLIC RECORDS RELEASE APPLICATION :Z zoo 5000, <br /> APPLICANT:_�O?Pft� .9 (t f0/I BUSINESSIAGI:NCY: 6q& 0o <br /> h4,.r <br /> ADDRESS: <br /> PHONE: FACSIMILE: <br /> TENTATIVE;APPOINTMENT DATE: Ea Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 01-r",,ECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESS EA 3 BUSINESS DAYS � ;�;� �:� ��� .�•' <br /> SIGNATURE OF APPLICANT DATE / <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. stBBt 33 ?7 L ; <br /> z. sued y ❑ Unit 1 <br /> s. 70a Gam" 1 ❑ Unit 2 <br /> 4. St" aty <br /> 5. street o Unit 3 <br /> d. Street q <br /> a. street M AAWF AMN I �euflit 4 <br /> a. truest ", <br /> P. streetI T <br /> Cj Unit 5 <br /> 10. stmt <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT C7 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ -SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) t3 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION STIES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 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 <br /> TIME <br /> DATE CONFIRMED " l'i101�iE <br /> FAX. <br /> :. INITIALS <br /> REVIEWED YES `NO REVIEW DATE . . <br /> PRE)4a•02-0DG <br /> W2003 <br />