Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
c VM CONDOR EARTH TECHNOLOGIES <br /> DATEREC -I. r No.0,304 P.- 1/1 <br /> sAN ;lora <br /> QUIN COUNTYPUBLIC H�ALT�H SERVICES fM`oc NuMeER <br /> : . I ENVIRONMENTAL HEAI,THi,DIVISlON <br /> 304 EAST WEBER AI/ENUE, THfRD Fl~b0R <br />! , STOCKTON j <br /> I I CA 95 0 <br /> �- ��'`- F �.I $ ! ! PUBLIC (209)469-3420 1# <br /> RECORDS RELEASE APPLICAMN . <br /> APPLICANT M,1 i Ic k, i�R�Si g <br /> 13USINESSIAGLNGY Co ii i° r– --4.4 <br /> V` c.�y�o{v 125 Trac, <br /> ADDRESS �f g8 bra r►k C�'r-coq k-i <br /> hay Gc.$-c C-A <br /> PHONE 2aq 2 3 QS'(� FACSIMILE 2 40'V <br /> �:o53B <br /> TENTATtVZ-APPOINTMENTDATE ( � r�2 '{ . <br /> (Please give T to 16 b 1, TlDlilw <br /> i <br /> �P,Fr o�sukimil#aI) I <br /> CHECK SOX TO EXPEDITE REQUEST-$87.00 <br />` sih[E5S DAYS , <br /> SIGNATURE OF APPLICANT <br /> DATE a Z r <br /> IM <br /> FILE ADDRESS IS THIS SIAr-EHD STAFF USE ONLY <br /> If PROGRAM ELLMENTS SEARCH <br /> /oat Mem cr'v�c f-. W. <br /> Oen @. aLt10.v� I�VQ D i. <br /> 3 <br /> 30 4U <br /> zssi A J <br /> a <br /> _ k <br /> t <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �NOERG•eROUND TANK(UST)CLEANUP SITE(LOP) 17 14OUSING AE ATEmENT Gi 50L113 WASTE FACILITY <br /> 9THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY { CI SOWA WA5•rL�V�llCI,I; <br /> [ �JNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOGS KENNEL f C1 SOUD <br /> DAIRY <br /> W—HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCIi 3I TIERd AKG TR1rJ4TM£NT PLANT <br /> !`n PED I=ACILITY U IYIOTEiJHOTEj_ f O PUMPER TRt1CK1YARDICHEM TOILM <br /> © TATTOO/BODY lBODY PEIRGING ❑ POO1.lSPA •.. � s' { <br /> © MEDICAL WASTE FACILITY ❑ q LAND USE APPLICATION SITES <br /> PUBLIC WATER SYSTEM Cl OTHER(PLEASE SPECIFY ABOVE) <br /> 7. List up to ten addresses in the Space above. Select the e s of tiles from the list above by checking <br /> the appropriate box(es). At least one file type MUST be epected. Fax to 1200,461:013$ or mall tot e <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 buxlness days but no later than ten(i o) days after receipt of applicatlon. The files � <br /> will be held for a maximum of five business days for review_ Appoiritinerlts should be scheduled <br /> accordingly. <br /> 3• A file that Is actively being worked on by EHD staff m4y not bei immediately available for review_ A now i <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 f <br /> of the applicant, Future file reviews by the same applicant may require a$57.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD Staff.. I <br /> 6. Applications received after 3:00 pm will be processed the next'1bus <br /> >irle <br /> s$day. <br /> j CONFIRMED APPOINTMENT•DATE <br /> TIME <br /> DA l <br />' TE CQNt'IRM1=l] <br /> PHONE FAX, INIYIALS <br />