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Jul. S, 2002 11:59AM CONDOR EARTH TECHNOLOGIES No.0268 P. 1/1 <br />DATE REC i WiD LOG NUMBER <br />SAN JOAQU COUNWPU13LIC HEALTH SERIES <br />ENVIRONMENTAL HEALTH DIVISION <br />a — �- UE D FLOOR <br />304 FAST WEBER AVENUE, 71itR <br />STOCKTON CA 9520.' � O <br />T (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT I C CL' 1`- M GQ I✓ BUSINESWAGENCY ttNO Lcx�+ 1 E F <br />AODRESS <br />PHONE_�'�-U�4-OST <br />N <br />FACSIMILE- . ' - d '( -'• % 3 4 — os 3 f3 <br />TENTATIVE* APPOINTMENT DATE TIME <br />(Please give 7 to 1��j <br />ss dd from date of a p11ration submittal) <br />u <br />CHECK BOX TO EXPEDITE REQUEST - $67. FEE - REQUEST PRO ED 1 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />D <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />JM UNDERGROUND TANK (UST) CLEANUP SITE (LOP) Q HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />2!1- OTHER CLEANUP SITE (NON -LOP) Cl FOOD FACILITY ❑ SOLID WASTE VEHICI..E <br />�) UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL © DAIRY <br />�j HAZARDOUS WASTE GENERATOR a CHICKEN RANCH 0 PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL O PUMPER TRUCKIYARp/CHEM TOILETS <br />0 TATTOOJ8ODY pE)RCING O POOLJSPA ❑ LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM © OTHER (PLEASE SPECIFY ABOVE) <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 (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 clays 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 />31 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 $87.00 deposit prior to review. <br />5. *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 />W <br />FILE ADDRESS <br />THIS SIDE END STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />5ZS <br />S, <br />Pb w <br />/IUD / <br />/i <br />pv <br />Li <br />5Itj7- <br />"A1)'.: <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />JM UNDERGROUND TANK (UST) CLEANUP SITE (LOP) Q HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />2!1- OTHER CLEANUP SITE (NON -LOP) Cl FOOD FACILITY ❑ SOLID WASTE VEHICI..E <br />�) UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL © DAIRY <br />�j HAZARDOUS WASTE GENERATOR a CHICKEN RANCH 0 PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL O PUMPER TRUCKIYARp/CHEM TOILETS <br />0 TATTOOJ8ODY pE)RCING O POOLJSPA ❑ LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM © OTHER (PLEASE SPECIFY ABOVE) <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 (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 clays 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 />31 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 $87.00 deposit prior to review. <br />5. *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 />W <br />