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CLL: <br /> IPM CONDOR EARTH TECH NO. 6865 1. 2 <br /> EHD LOG NUMBER <br /> -SAN JOAQUIN CO=Y <br /> EN moNmNTAL HEALTH DEPARTMENT <br /> 2 304 East Weber Avenue,3d Floor, Stockton,CA 95202-2705 <br /> J O(P Telephone: (209)468-3420 Fax: (209)464-0138 Web:wwvr.sjgov.org/ehdZ3513 <br /> PUBLIC RECORDS RELEASE APPLICATION � I <br /> APPLICANT: ( -k BUSINESSIAGENCY: <br /> ADDRESS: IZG T I <br /> PHONE(1): - l2Sl g PHONE(2): Z0171 (00('000 - FACSIMILE: Q�I B <br /> TENTATIVE*APPOINTraENYDATE: gIIrI Time:J13DEd, <br /> (Please allow 10 business days from datM(GASHECK <br /> submittal-'Tentadve only•must be confirmed) <br /> El CHECK BOX TO EXP E 57-$93-00 F ONLY)•REQUEST PROCESSED IN 7 BU INESS DAYS <br /> SIGNATURE OF APPLIC T DATE 51310(11 <br /> UNIT DISTRIBUTION ❑un' 1 ❑Unite ❑Unitana4 ❑UnItS 0 Unita ❑ Other(AectrcnlGlistsf ys) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> 1. OA Ant D Q <br /> 2. A-AI o, <br /> 3. CR <br /> A. I \� <br /> 5. <br /> 7. 119.A Elet <br /> 9, d <br /> 10. 0q p <br /> Specific Date Range of Information Requested:From to <br /> 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP Sim(LOP) 11 Houma AoATEa1ENT IlYSOLM Wnsrt FAaVNfV%HICLE <br /> ❑ HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 13 YWSTE TRE <br /> OERGRDUNO TAM(MONRORINGIREMOVAL) ❑DOG KENNEL ! f,10 <br /> HAZAROOUSWASTE GENERATOR 13Cmmm RANCN �ilASTEWATER TREkTIMEW PLANT <br /> ❑TIERED PERMITren rAciL ❑MOTELJHOML- ❑PVMPER TRUc K1YARnICKw TOILETS <br /> ❑TATTOOIBOOY PIERGNG ❑POOUSPA ❑LANO USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL MOSEPMC PERMa RECORDS ARE AVAILABLE FOR REWEW - MONDAY-FRIDAY S:00 AM-&OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 Or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled 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 of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> i �!I <br /> tom• <br /> END�E.v1-ooh <br /> 1/19105 <br />