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JUN-1'(-20W5 16:19 CONDOR EARTH TECH 209 532 0773 P.02 <br /> a"i VAA ,IU1LJN %.V Ul'q 1 Y l <br /> fl-EC'SVEDD - trIVIRONMENTAL HEAL IH DEPARTiv1ENT <br /> . 304 E Weber Ave V Floor Stockton, CA 95205 <br /> y Ir 0 20Y9)468-3420 Fax: (209)444-0138 Web;w".co.san-jo&qufiLcaus/ehd <br /> ca.us/ehd <br /> Z;VIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICAT'TON <br /> t .,. ..a� -tom• --- - - — <br /> APPLICMT: �Ar.;�k & A t_z 2 T_BUSINESSIAGENCY K 1 CC11 f ,,/A e <br /> ADDRESS- <br /> PHONE: 2-09 + S75 _436.1 ..FACSIMILE; �9. 3 a. 6:7 <br /> TENTATIVE'APPOINTMENT DATE: T Q9L,,Lo n2005Time: <br /> (Plaaae allow 14 buslns=days&am of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FR-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> f Depntt ant Use OnIV <br /> FILE ADDRESS UNIT <br /> ,. street l d <br /> a ❑ Unit 1 <br /> 2. sv.et _ <br /> 3. &veer J2,10 a . <br /> / -U'nit 2 <br /> , /tJ <br /> s. sneer D 5 r-i a.1 Ave. d A <br /> Unit 3 <br /> 6_ svaN 9 S. ot, 12 9z. <br /> 7. neats- I a <br /> knit 4 ' L V <br /> tt. Street 1 dA ca&izx, - � ` fix- z r <br /> 9. Sinde%co,6W. a+ r <br /> ❑ unit 5.. <br /> so. $tree, <br /> Z,44 5 aclGfi'on <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES tit <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CG HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SnE(NON-LOP) ❑ FOOD FACILITY SOLib WASTE VEHICLE <br /> IJNDERGROuND.TANK(MdIMITOWNGnzEmoVAL) 17 DOG KENNEL 9d DAIRY <br /> OAYAPDOUS WASTE GENERATOR 0 CliICIM RANCH O PKG TREATMENT PLANT <br /> p TIERED PERMITTED FACILITY O MOTELHOTEL Q PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOMODY PIERCING ❑ POOLISPA FL LAND USE APPLICATION SPIES <br /> J8r MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) - <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected, Epx to 20 464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHb will notify the applicant if any E"D files exist Art appointment for review will be confirmed <br /> approximately five business.days but no later than ton(14)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 flie 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 EMD 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 RMEW DATE <br /> �FIf3 X6-02-006 . <br /> 81drSO43 . <br /> TOTAL P-02 <br />