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NIF <br />` DA1Ma)y , 21 . 12003, 4 : 21PM CONDOR EARTH TECH_NOL_OGIES No • 3 .303 "'P . I �' 1 <br /> n1L L � \' k� II )) E 'IRONMENTALHEALTH DEPART AT <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> MAY 2 7 Z003 STOCKTON CA 95202 <br /> (20°') 468.3420 <br /> INVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLIC.AT14 a � -70a <br /> hV <br /> APPLICANT BUSINESStAGENCY <br /> ADDRESS r'AAt.1CIacr,.d. j, -- <br /> ��^^ <br /> PHONE / ���Q� l ? FA=MILIS '�3t{ ` O 'iZ i.. .�.._._— <br /> TENTATIVE' APPOINTMENT PATE TIME _11.1116�!( ? OVM, 1r�3��> ( � <br /> (Please give 7 to 10 business days from date of application suhm.i"all w/ <br /> HECK BOX TO EXPEDITE REQUEST " $89100 FEE REQUEt: T PROCESSED IN 3 BUSINE38 DAYS <br /> SIGNATURE OF APPLICANT _ � 114TE <br /> FILE ADDRESS THIS : IDH EHn 3TgFF USE ONLY <br /> PROGRAM ELIEMENVIS SEARCH _ <br /> IF IF, <br /> ON , Sc'f�. 'r I ® ' ?-7- -- -- — <br /> AMAAt <br /> GX' 570---- 4IF <br /> ✓.F!x0 •:✓. ..:�..2(e <br /> r IF <br /> El <br /> FFe <br /> t - — - <br /> ENVIRONMENTAL HEALTH DIVISION BLES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT OI.1D VV ASTE d'ACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY 0;;01;0t..10 V1 ASTE VEHICLE <br /> UNDERGROUND TANK (MONITONG)REMOVAL11) DOG Ki:NNEL ❑ IIAIRY <br /> HAZARDOUS WASTE GENERATOR CI DOG <br /> RANCH EIPKG TRIE,1ITMENT PLANT <br /> TIERED PERMITTED FACILITY Q MOTELiHOTEL ❑ BUMPER TRUCWYARD/GHENT TOILfcTS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA b LMID UTE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE <br /> 1 . List up to ten addresses in the space above. Select the type(s) of flleu from the list above by checking <br /> the appropriate box(es). At beast one file typo MUST be selected. Fax to 20'P 43!6-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD flies exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after rereipt of application. The files <br /> j will be held for a maximum of five business nays for review. Appointments elhould 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 ie available. <br /> Al,. Any file not returned In the same condition a:I released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the wime applicant may require. II $81 ).00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must he confirmed With EHD stall. <br /> 6. Applications received after 3 :00 pm will he processed the next businem day . <br /> FF <br /> CONFIRMED APPOINTMENTDATE . TIME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWED YES NO REVIEW DATE: <br /> FIFIFFE 4"Za�aTiWa �"' - - <br /> arzerzaaa <br />