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JUN-1Y-2005 16:19 CONDOR EARTH TECH 209 532 0773 P.02 <br /> . J VAl um, %,V U1N 1 Y <br /> � C Eir V1RONMENTA�HEALTJI DEPARTMENT <br /> 304 E Weber Ave 3 Floor Stockton, CA.95205 <br /> U ?0099)468-3420 Fax: (209)444-0138 Web:www.co,san-joaquin.ca.us/ehd <br /> Z-14VIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> rc� <br /> APPLICANT;- f AT`q C6A 7_A �7 DUSINESSIAGENCY: C4 X1 tjQ R_ CA d TC—Ch1 A,r <br /> ADDRESS: 0:t16&:S Bj2jqN LANE <br /> PHONE: 293 2 •_Omo I FACSIMILE: <br /> TENTATIVE•APPOINTMENT DATE: 02oo Time: p <br /> (Please allow 10 buslrross days from 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 /> De"ftent Use Only <br /> FILE ADDRESS UNIT <br /> ,. sveetfill tkp Unit 1 <br /> 2. suee� 3 . a <br /> 3. Wee10 a Ink— <br /> 'R— <br /> Unit 2 <br /> 4. sum a t <br /> s= svem 9.w ve. oty A Unit 3 <br /> e. "WON 9.9 6, O L <br /> 7. So" It In. S" I Q Unit 4 <br /> a. suem 110 5 a. <br /> 9. Sued ❑ Unit 5 <br /> L.iL sues '¢ 5 or�kCfom <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES met <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILrFY SOLJD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 17 PUMPER TRUCKIYARVICHEM TOILETS <br /> [a TATTOOMODY PIERCING M POOLISPA FC-LAND USE APPLICATION SITES <br /> Air MEDICAL WASTE FACILITY to 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)464.0138 or mail to the <br /> address Indicated above. <br /> 2. EHI)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 reorganized 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 /> 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' INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EM 4"2-0oc <br /> wanoos " <br /> TOTAL P.02 <br />