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DEC. 8. 20.03 2: 16PM CONDOR EARTH TECH NO. 1697 EIicP. It4umBER <br /> DATE RECEIVED *Amp." J SAN OAQUIN COUNTY y� <br /> i=_;r''�;y/; -; E+NVMONNffNTAL EEALTH DEPARTIVIZ+SIT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> ()[ V WJ.S 468-3420 Fax, (209)464-0138 Web:www.co.san-joaquin.caus/ehd <br /> =N`ti'i i-;N1VILfv! -i �,i_j . PUBLIC RECORDS RELEASE APPLICATION <br /> � <br /> 6USINE551A <br /> APPLICANT: GENCY: 1 <br /> ADDRESS:L?T J j CLQ S t OG KTo <br /> ILE _,�-a� 0 3 <br /> PHONE�O� 'r FACSIM - <br /> TENTATIVE=APPOINTMENT DATE: 3 Time. 7 .— A' <br /> (Please allow 10 business daysfrom date of appllratlon submittal) <br /> El CHECK 13OX TO EXPFDrrE REQUE 3.00 PEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �3 <br /> Department Use Only <br /> UNrr <br /> FILE ADDRIrSS <br /> sunt st ❑ Unit 1 <br /> Unit 2 <br /> 3. Sheetc2 77 1 <br /> ` i ate Unit 3 / <br /> e- StreM O G <br /> 7 Strcd KW <br /> a- Street 2 Y �c1 /YIDunit 5 <br /> 9. straM hh <br /> 10. smm V O <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> j UNDERGROUND TANK(UST)CLEANUP SITE(LDP) E3HOUSING ABATEMENT Q� SOLID WASTE FACILITY <br /> X OTHER CLEANUP SITE(NON-LOP) L U FOOD FACILITY SSI SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL IO DAIRY <br /> HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑ PKG TREATMENT PUNT <br /> VVQtt��� TIERED PERMITTED FACILITY ❑ MOTE.JHOTEL M PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING M POOLISPA ❑ LAND USE APPLICATION sITEs <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECK <br /> 1. List up is ten addresses in the space above. MUST be type(s) <br /> Fax to 209 4of riles from th164-Oi 8 or mis be ail to the <br /> the appropriate box(es). At least one file type <br /> address Indicated above. <br /> 2. END will notify the applicant if any END 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 reorganized by END 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 /> 5. '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 /> DATE CONFIRMED 'PHONE FAX INIT1At.S• _ <br /> REVIEWED YES NO REVIEW DATE' <br /> - <br /> M 4"2-406 <br /> 4lagatl'J - <br />