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DEC--13-2004 12:53 CONDOR EARTH TECH 1-1 209 532 0773 P.01i0: <br /> [LATE RECENED __ �� ! EHD LOG NVIv Z <br /> SAN JOAQUIN COUNTY <br /> E"NVKoNmFNTAL HEALTH DybARTm_�, <br /> NT <br /> f DEC 1 ,3 2004 - 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:wWw.co,san joaquhLca.us/ehd <br /> 1ICi-t�l <br /> PE R MI' '' R'JlES PUBLIC RECORDS RELFASIP. APPLICATION <br /> m <br /> AMUCANT: W=W=ENCY:_-am <br /> b0 l A STH- �f� of S <br /> ADDRESS AW". <br /> PH4N FACMi[LLE: <br /> TENTATIVE+APPMTMEff DAT> I �`' p cerr, Qnn, $ '.50 i4 M <br /> (Pirie-allow 10 bud�da%hoar loos of appnreuan subnditQ . <br /> jr <br /> 29- CHECK BOX TO MWOM -$9.90�--REQUEST Pti0C=ED IN 3 BUSRGW DAYS � ILL <br /> SIGNATURE OF APPLICANT 'DATE .1 �-0704"' <br /> Deparlsnent Use Only <br /> I <br /> FILE ADDRESS UNIT <br /> IL abod rtr a u 1 Unit 1 <br /> z s 3 <br /> a. s� 13 Unit 2 <br /> .. <br /> s. so-eet x a Unft 3 �l V <br /> Unk <br /> m 3'o yr m CO, rte« >z �5q �r r'� UUy- , <br /> a. sr DN Ftc- RAILROAD �"'�� ;�i3-� L C-i��1' Sf � Units C 1(j/4l <br /> 10. 9aee1 - r! <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK WS7)CLEANUP SITE(LAP) 0 HOUSIX6 ADAVEMENT t SOLJDWASTEFf;OTHER G>_EANUP SITE(NON-LOP) d FOOD FACILITY SOLID WASTE <br /> UNDERGROUND TANK(INONITOMS(REMOVAL) O DOG KENNEL Af DAIRY <br /> HAZARDOUS WASH GENERATOR 4P CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMn7m FACnm E] MOTELIHOTEL ❑ PUMPER TRUCWARD1CHE9 TORETB <br /> CI TATr00I803Y PIERCING o POOLISPA X LAND USE APPLJGATION SITES <br /> 19 MEDICAL WASTE FAGBJffY 0 =ER PLEASE SPEC>Fn. . <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above py checklnt <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 46"138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHO 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 Tae scheduled <br /> accordingly. - <br /> 3. A file that Is actively being worked on by EHO staff nay not be immediately available for review. A no, <br /> application may be subrinitted 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 expens <br /> of the applicant FLdure file reviews by the same applicant may require a$93.00 deposit prior to-rovie, <br /> 5. *TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT I)ATE TIME <br /> S - <br /> DATE CONFIRMED 'PHONE FAX' 1NMALS'', <br /> REVIEWED s- YES NO RMEW DATE' _. <br /> TOTAL P.O: <br />