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DEC. 8. 2003 2: 16PiN CONDOR EARTH TECH N0. 1697EHLP. 1NUMeEJ� <br /> DATE RECEIVED SAN JOA.QUIN COIJNT14 <br /> Y <br /> � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> 1�' V 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehdul <br /> I <br /> PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> r /�I/— n <br /> APPLICANT: h`I- � ( `%I/l�,,r�)�'F'�-' _L_auSINESSLAGENCY: ���)ba F<- <br /> �n P7� n�� ' <br /> ADDRESS: V�/ j CLE S I r jOG K-TO <br /> PHONE('�A 23 f -FACSIMILE: D S <br /> A! <br /> TENTATIVE- p[ <br /> E'APPOINTMENTDATE: � )-� o3 Time:-=�--- ^^� <br /> ay ,. <br /> (Ploase allow 1Q business daysfrom date otappllration submittal) n <br /> CHECK I3OX TO EXPEDrrE REQUES -f93.00 FFE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT C <Xi,' n DATE �3 <br /> DeoaMnmt Use Onty <br /> UNIT <br /> FILE ADDRESS <br /> sv $ ❑ Unit 1 <br /> 2 Street � 5 _ _ G <br /> 3. Seem A C 2 <br /> 3 <br /> ;r e. s.eet c' <br /> u G Unit Mftb <br /> _� <br /> e. s F f' a, <br /> K s. sw<t O G ❑ Uni <br /> to. seem O ° e�ln, <br /> 9' ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINGARATEMENT SOLID WASTE FACILITY <br /> �./OTHER CLEANUP 511E(NON-LOP) U FOOD FACILITY SOLID WASTE VEHICLE <br /> iyr UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Cif 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTELIHOLEL t3 PUMPER T'RUCKIYARDIC M To <br /> TIERED PERMITTED FACILITY P POOLlSPA j3LAND USE APPLICATION SITES <br /> ❑ TATTOO760DYPIERCING <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)_ Jj <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list abaye;by checking <br /> the appropriate bOX(es)- At least one file type MUST be selected. Fax to 209 464-0138 of 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 sheduted <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 /> 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 /> REVIEWED - YES NO REVIEW DATE' <br /> END 4sa2aos <br /> NeRno7 <br />