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DEC. 8. 2003 2: 16N CONDOR EARTH TECH NO. 1697EHEP. ]NUMBER <br /> DATE RECEIVED <br /> Sax doaQTJmr COUNTY <br /> ENVMONAf.ENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> 11[ n 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.c&us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> L.I-,IVII J7 Iii /'7 /� <br /> APPLICANT:�I F,1 C'=^�C)�,l',FiL�L BUSINESSIAGENNCY: (Ot")bOr �5_Ar�Tf+-T�-Jcfau'A5- <br /> ADORESS: CL,, STE. OG KTo <br /> PHONE��o� -��u `7!� FACSIMILE: 6�2� 0 S <br /> TENTATIVE'APPOINTMENT DATE: OCz.- Lx, � o- Time: I ' <br /> (Please allow 10 business dns from date of application submivaq <br /> L. n Fr <br /> ��ryy <br /> CHECK BOX TO EXPEDITE REQUEST-193.00 FEE-REQUEST <br /> /PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _—! �J�l� DATE g �3 <br /> Department Use Only <br /> FILE AODRE55 UNIT <br /> street rn ❑ Unit 1 <br /> 2. Street S G <br /> 1. $t,et f E G 2 <br /> s. set114 <br /> p 3 <br /> .f 9. Sreel 0 - Gi <br /> 7. S reC <br /> -city <br /> nit <br /> X A. :x4oR I F I n <br /> X 9. Strutt t p G - - '' ❑ Uni <br /> ' 10. SUeet D O Pl"fti <br /> 9, ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINGABATEMENT sot.10 WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) n FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA2ARDOU5 WASTE GENERATOR 17 CHICKEN RANCH ❑ PKG TREATMENTP <br /> PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL t3 PUMPERTRUCKTYARDI M TOILETS <br /> a TATrO01SODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION TE5 <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) JE - <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list aboye1tby 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 Tiles exist. An appointment for review will be co�Tflrmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The Tilos <br /> will be held for a maximum of five business days for review. Appointments should he sEheduled <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 INfiIALS . <br /> REVIEWED - YES NO REVIEW DATE' <br /> EHD 4502-006 <br /> Neno02 ' <br />