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do • 26 . 2005 1 20P CONDOR EARTH TECHNOLOGIES No -4748 P . 1/I <br /> ORTE AECF1VEo <br /> EM LOG fiUrttlER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> r COI) 304 EAST WEBER AVENUE, THIRD FLOOR N41 <br /> STOGK70N CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q� � ?a- ; BU51NE1SSIAGENCY <br /> ADDRESS �7 <br /> PHONE � '- „�I�] FACSIMILE ' ' <br /> TENTATIVE'APPOINTMENT DATE Q U TIME 9' ea'yi-N . w <br /> (Please give 7 to 1e business d6jh from date of application submittal) `7 <br /> CHECK BOX TO FYPEn17E REQUEST-$87.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS ' ' <br /> SIGNATURE OF APPLICANT � DATE - D 3 3 <br /> FILE ADDRESS 7741S SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH - <br /> O -f iYl <br /> 07 6 G O <br /> j9 Uft <br /> F PA <br /> l ENVIRONMENTAL HEALTH DIVISION FILES <br /> .PS UNDERGROUND TANK(UST) CLEANUP SnE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) C FOOD FACILITY U SOLID WASTE VEHICLE <br /> y UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> y- HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKiYARO/CHEM TOIL.EIS <br /> TATTOO/BODY PEIRCING 0 POOLJSPA - 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPEC1FYA9OVE) <br /> ) C <br /> 1. List up to ten addresses in the space above.'qSelecf4e types) of files from the list above by checking <br /> the appropriate box(es), At least one file type MUST be selected. Fax to (209)464-0138 or mall to the <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 business days but no later than ten (10) days after receipt of application. The flies <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <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 <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be�confirmed with EHD staff. <br /> 5. Applications received after 3;00 pm will be processed the next business day, R L5 <br /> CONFIRMED APPOINTMENT DATE TIME <br />