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JIJN-1'(-2U1J5 16:19 CONDOR EARTH TECH 209 532 0773 P.02 <br /> 0AIN JVAYLWN %—UUPI1 Y <br /> EMRoNwNTAL HEALTo DFPAR7[MNT <br /> 304 E Weber Ave P Floor Stockton, CA.95205 F <br /> U ?_O99)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquiiLca.us/ehd <br /> ONVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: PA-17,-9 6jL >C� 7 e.I_c:Z- _DUSINESSIAGENCY; l4 X11 15 fZ— At7X K .fJ /A,r <br /> ADDRESS:_ ���� P�Rh� CANE <br /> PHONE: 2,ocl3 e2_ d� I FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: ad Time:�� : Q A4 A� � `+CJ' A, p/ <br /> (Please allow 10 business days from da a of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE C, <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. 3veet ( d O Cl <br /> Unit 1 <br /> 2. svee4 3 a <br /> 3. sveet l VPt 4 a Unit 2 <br /> 4. dty <br /> s. sveee <br /> d-us ►-ia.l AVe. a <br /> B. svae� 2:1 S. o. a /Unit 3 <br /> 7. St-eel s- PbJ ta A ye. aty Unit 4 <br /> a. Stra 710 SA ca rja- <br /> 9. s„"` ❑ Unit 5 <br /> 10_ Sued 9 4 5 . o�/Cfio nyo A <br /> J � ENVIRONMENTAL HEALTH DEPARTMENT FILES #-A;4r <br /> C] HOUSING ABATEMENT SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> ❑ DOG KENNEL 92f DAJRY <br /> Q f, ❑ CHICKEN RANCH 13PKG TREATMENT PLANT <br /> —9 f ❑ MOTEUHOTEL 13 PUMPER TRUCKIYARVICHFM TOILE <br /> ❑ POOLISPA K-UWD USE APPLICATION SITES (P <br /> 0 OTHER(PLEASE SPECIFY) `f` 8 <br /> ice above. Select the type(s)of files from the list above by checking <br /> g / <br /> me file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> 'EHD files exist An appointment for review will be confirmed <br /> 1 / but no later than ten(10)days after receipt of application. The files <br /> C) "( business days for review. Appointments should be scheduled <br /> on by EHD staff may not be immediately available for review. A new <br /> 70 n the file is available. <br /> "L ondition as released will be reorganized by EHD staff at the expense <br /> rs by the same applicant may require a$93.00 deposit prior to review <br /> ust be confirmed with EHD staff. <br /> o. HppncaTlons receivea aTter a:uu pm Will be processed the next business day. <br /> CONFIRMED APPOINTMI=NT DATE TIME <br /> DATE CONFIRMED PHONE FAX' INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EM ae-02-006 <br /> 9x612003 <br /> TOTAL P.02 <br />