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MAY. 3, ZOG6 3 1 PM CONDOR EARTH TECH - N0. 6865 P. 2 <br /> *1" *400 EHD LOG NUMBER <br /> -SAN JOAQUIN COUNTY <br /> ENYMONMXM A,L JUAALTH DrPARTMENT <br /> DkO304 East Web-.r Aventte, 3d Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)4615-3420 Fsa:(209)464-0138 Web:wwvr.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; % Q HUSINESSIAGENCY: I. r� <br /> ADDRESS• <br /> PHONE(7): - �$ PHONE(2): �� (0Ol—00� FACSIMILE r Q l <br /> TENTATNE"APPOINTMENT DATE. 6' l Time: •ho fn. . <br /> (Please allow 10 Wsittess days frau+date of ori submittal-*tentative artly-+dust be confIrmed) <br /> © CHECK 13OX TO EXPST-;93.00 F (CAS �ngOK )-REQUEST PROCESSED IN 3 BU INE S DAYS <br /> SIGNATURE OF APPLIC T DATE 6 131040 <br /> UNIT OiswuBUTIGN ClUn' 1 m Unita is Unit! nit 4 D UnIt 5 A Unit 5 ❑ Qther(eiectrvnfcflist%f ps) <br /> FILE ADDRESS EHD USE ONLY Fa <br /> Street Street Name City <br /> 1. a� AIS 4 <br /> 2. N n, <br /> 3. I DUD P5Lr _ <br /> 4 f7 15- WAORV= <br /> r. \ <br /> 6. �a bLn �- <br /> 7. 10-A L', <br /> 00 <br /> S. t? <br /> 10. 17 A <br /> Specific Date Range of Ipfolmation Requested:From _-- to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> i(UNDERGROUNG TANK(UST)CLEANUP SITE(LDP) El fa HOU91NG A9ATEMENT S1*L1 WIST9 FAaLmN1:114IG1-s <br /> UPTHRA CLEANUP SITE(NON-t,OP) E3 Fool)FACILITY CI WASTE TIRE <br /> P=OERGROUND TANK(MONr'rORING1RzmoVAL) 13 DOG KENNEL IM pAwy <br /> IiAr V11S WASTE GENGMYOR E3 CHICKEN RANCH PfYjA3TffWATFR TREATMENT PLANT <br /> Q TiERC-o PI FACII.W 0 MOTt].lI'iQTEL• O PUMPER TRUCKIYAWCtiev ToiLETS <br /> *TATrao/BooY PIERGNU Z3 POOLlSPA 10 LAND USE APPUCAVON SITES <br /> 13 MEDICAL WASTE FACIL.rTY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERmr r RECORDS ARE AVAILABLE FOR REvtEw- MomDAY-FRIDAY 5:00 AM-r:00PM - EXCLUDING HOUDAYS. <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking the' <br /> approptfate 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. Appoiftnems should be scheduled accordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> a. Any file not returned in the same condition as released will be reorganized by E,.HD 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 /> r Ij'% <br /> END�E-v2-L06 <br /> 31t4r0.5 <br />