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UCT-13-2004 09:49 CONDOR EARTH TECH 209 532"07,3 P.01/0. <br /> DATE RECEIVED EHO LOG NUME <br /> SAN JOAQUIN COUNTY <br /> ENVMOZV M�TAL REAi DEFARrAENT <br /> ? 2004 304 F,Weber Ave 3rd Floor Stockton, CA.95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web.www.co.san joa .ca.us/ehd <br /> Z67Z <br /> - PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 13USINE=AGENCY: <br /> ADDRESS: <br /> PHONEC. �� a te)) [ U FACSIMILE. <br /> TENTATIVE"APPOINTMENT DATE. �� C`lo�J1� oc[CJ77me: Fi � � AN <br /> (Please allow td bminess days from date of appflratlan submits) <br /> In CHECK BOX TO EXPEDITE_REQUEST.$93.00 FEE-REQUEST PROCESSED IN 3 BUStNM DAYS F11- <br /> P Y <br /> SIGNATURE OF APPLICANT DATE <br /> DeoarIxmnt Use Ordy <br /> FILE ADDRESS upw <br /> s� L ATHTzo <br /> z Wanes M <br /> a- sage. S' Unit <br /> k saw OD 96 <br /> IW— s L /V a <br /> Unit 3 <br /> q0s� p 1� <br /> 3 Cl 7. sa.�, ally 0/ Unit 4 <br /> e. sweet <br /> 9. SOW ❑ Unit 5 <br /> ,o. sand aN ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES VhI v� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING AgAtENIENT W.SOUD WASTE ILITY \ <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACAITY �SOI.m WASTE VeU <br /> UNDERGROUND TANK(MONR'ORINGIREMOVAL) Q DOG KENNEL Fr DAIRY -XI <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> gr TIERED PERMITTED FAl:IL Y ❑ MOTELAMTEL ❑ PUMPER TRUCKlYARDlC>iF.tA TOI �v <br /> ❑ TA7 rOOIBODY PIERCING ❑ POOLISPA LAND USE APPLICATION sREB <br /> ❑ IMEMCAL WASTE FACILITY ❑ OTHER(PLEASE SPECIF`t) , <br /> 1. List up to ten addresses in the sparge above. Select the type(s)of files from the list above by chest .n< � <br /> the appropriate box(es). At least one file type MUST be selected. F to[20146"138 or Snail to the ` <br /> address indicated above. f <br /> Z. EHD will notify the applicant if any EHD filers 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 scheduled <br /> accordingly. <br /> 3. A file that is acthrety being worked on by EHD staff may not be Immediately available for review. A ne, <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 expens, <br /> of the applicant. future file reviews by the same applicant may require a$93.00 deposit prior to revwi <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. 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 REMEW DATE <br /> TnTLll P P <br />