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Auo•25. 20D 1 :2081,1 , CONDOR EARTH No•4748 F• 1/1 <br />aA:E REC8VED <br />EmO LOG Nitm%en <br />SAN .lOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />AUG � J Z0�3 304 EAST WEBER AVENUF, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT Q.i _ BU3INESSIAGENCY 1 F y.. <br />ADDRE=SS <br />PHONE FACSIMILE <br />TENTATWE* AFPoIN-rmENT DATE _ cio�l� -nME <br />(Please give 7 to la btrain� ss d& frarn d2te of sppll"Von submittal) <br />9- <br />XCHECK BOX TO EXPEDITE REQUEST . $87XQ FEE REQUESTPROCESSED IN 3 BUSIAIF-SS (JAYS <br />SIGNATURE OF APPLICANT � DATE <br />.03 V�� <br />.. . '00 <br />.ter • ! _.... ti ,���.�� <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />1UNDERGROUND TANK (UST) CLEANUP SITE (LOP) d HOUSING ABATEMENYSOLID WASTE FACi1J1Y <br />OTHER CLEANUP SiTt (NON -LOP) ❑ FOOD FAC1LriY i191,SOUD WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGn EMOVAL) 0 DOG rrNNEL ❑ DAIRY <br />HAZARDOUS WA$Irz GF_NERATOR t7 ' CHICKEN RANCH I;J PKG TREATMENT PLANT <br />TIERED PE1RWI I FACILITY M' M0TEUHOTI=L [3 PUMPER TRUCKlYARDJCXEM TOILETS <br />TATTOOIBODY PMRCING C1 POOLJSPA - 0 LAND USE APPLICATION SRE—S <br />MEDICAL WASTE FACILITY � PUBLIC WATER SYSTEM Q OTHER (PI EASE SPECIFYA60VE) <br />1. List up to ten addresses in the space above. 4elecT the type(s) of files from the list above by checking <br />the appropriate box(es), At least one file type MUST be salected. Fax to 209 4641 8 or mall In e <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 latirr than ten (10) days after receipt of application. The files <br />will be hold 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 EHO 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 rexieWs by the same applicant may require a $87.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be -confirmed with EHO staff. MISMIMk <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE T)ME <br />