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.1 Aua •28 . 2003 9: 16AM CONDOR EARTH TECHNOLOGIES NO 4d 1 0 r . <br /> EMO LOG NUMDER <br /> SAN .lO.'O.UIN COUNTYPUBLIC HEALTH S6RV10ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AUG 2 2003 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKCTON CA 95202 1461 <br /> ENVIRONMENT HEALTH (209)468-3428 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> Y^ <br /> APPLICANT- xC'�.,�e_;�.BUSINE331AGENCY. C..�_6a f- '��„r"�QADDRESS I FY 1�/in C l rCL At <br /> PHONE FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE' cZOD :�' TIME <br /> r�17� (Please give 7 to 10 business from date of application submittal) <br /> lad-.CHECK BOX TO EXPEDITE REQU - 87.00 FEE-R QUEST PROCESSED IN 3 BUSINESS DAYS <br /> VVVNNN /J <br /> SIGNATURE OF APPLICANT O I� DATE o2`� C f l� D <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY O <br /> PROGRAM EIFME „^ <br /> I L <br /> '3 r <br /> aa-41 <br /> f F <br /> 6 0 o IEEE <br /> ^: <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 12HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑-CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMn'TED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> � TATTOO/BODY PURGING ❑ POOL/SPA ❑ LAND USE APPLICATION SnES <br /> Y MEDICAL WASTE FACILITY 11Y 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 days but no later than ten (10) days after receipt of application. The files <br /> will he 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 $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 /> S 14 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />