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JUN-1Y-2005 16:19 CONDOR EARTH TECH 209 532 0773 P.02 <br /> I �r� OAf4 JVAIIUM k UU1V1 Y <br /> RONMENTAL HEA.LTit DEPAAAENT <br /> 304 E Weber Ave 3'l Floor Stockton, CA.95205 ' O <br /> N 2 0 20199)468-3420 Fax: (209)464-0138 Web:www,co,san joaquin.ca.us/ehd (// <br /> &VIROWENT HEALTH PUBLIC RECORDS RELEASE APPLICAT14 <br /> /1 t <br /> APPLICANT: PAY.Lti�6_iZA .,c7BUSINESS/AGENCY: S4,m�a& �rZYH IC- b 1n'r,�„_ <br /> ADDRESS: CgPr= <br /> PHONE: 2z,,::j + $1J e2_ 03(o I FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: .00 Time: g : j�>Q 6M <br /> (Please allow 10 business days from da a of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. suesfill 0 Cl Unit 1 <br /> 2. sv" 3 CIN 4 14I r <br /> a. srW Irl ❑ zJ �nit2 <br /> a, Snea d �' <br /> s svee us Fla( Ve a IY! �Unit3 <br /> s aN 9.4 S, G <br /> 1. % 5 1 a ;!<UnR 4 <br /> Str.m I I <br /> B. eM 71 O 5 - f0.. <br /> X06to. ❑ Unit 5 <br /> m. s� F-14 5. ookf-o- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES fievis;-V <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENTx SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY �Y,.,7/SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONMORINGIREMOVAL) 1737 <br /> DOG KENNEL d DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> n TIERED PERMITTED FACILrry 0 MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> Q TATTOO/BODY PIERCING ❑ POOLMPA FC-LAND USE APPLICATION stiEs <br /> J2r MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 4640138 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 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 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 reorganlzed by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONE . FAX INITIALS' <br /> REVIEWED YES NO REVIEW DATE <br /> E ae 2a 6 <br /> aianoos <br /> TOTAL P.02 <br />