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.� Aa- )8 . 2003 9 : 160 CONDOR EARTH TECHNOLOGIES No .4816 P . Iii <br /> .DATES ER _ ! END LOG NUW3ER <br /> 'i \"i�E�II� 'gI SAN JONUIN COUNTYPUBLIC HEALTH SERVICES <br /> n,_�, ,�I \i ��. 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AUG 2 � 2603 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEAL H (209)468-3420 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 1 <br /> APPLICANT; `�- �4�I �.�_�._BUSINESS/AGENCY CCTGI_f="W��_ <br /> ADDRESS <br /> PHONE nl-..k FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE -.0tczoy TIME -50 0, <br /> r./717� (Please give 7 to 10 business days tram date of application submittal) ' ' M <br /> y+.i CHECK BOX TO EXPEDITE REQ - 87.00 FEE--R QUEST PROCESSED IN 3 BUSINESS DAYS �`1i i�• 'J�a S� <br /> SIGNATURE OF APPLICANT DATVVi��ag <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY O <br /> PROGRAM ELEME <br /> 02 8 a <br /> g rVfnN <br /> aa-6 <br /> I 30 0 o <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) f7 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) In DOG KENNEL. CI DAIRY <br /> HAZARDOUS WASTE GENERATOR 1 CHICKEN RANCH Q PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL [I PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOCIBODYPEIRCING b PdCuSPA - • 0 LAND USE APPLICATION SrfES <br /> Y MEDIGAL WASTE FACILITY tr PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVE) <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 ma(l to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD flies 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 EMD 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 /> 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 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />