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Jul• 8. 2002 11 59AM CONDOR EARTH TECHNOLOGIES No -N b8 P. / <br />GATE flE d - <br />SAN JOAQ10* COUNTYPUBLIC HEALTH SERNUES EJm LOG M1619EA <br />D_ ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />0 <br />STOCKTON CA 95202 90 9 <br />(209)468-3420 <br />a PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT. NIIG I{I l— M4114E�7U_ BUSINESSIAGENCY <00411 OP— <br />ADDRESS <br />PHONE? <br />TENTATIVE' APPOINTMENT DATE TIME <br />(Pisase glve7to10 buil sys from ateof application Submittal) <br />CHECK BOX TO EXPEDITE REQUEST -$e7. FEE— REQUEST PROCEED3BUSINESS DAYS <br />SIGNATURE OF APPLICANT 44 c DATE <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. EHD wiil 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 $87.00 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 <br />TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />ENVIRONMENTAL HEALTH DIVISION <br />FILES <br />)M UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />JS OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />P UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />13 DAIRY <br />1?5 HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTFL <br />❑ POOUSPA -• • <br />❑ LAND USE APPUCATION SITES <br />O TATTOOIBODY PEIRCING <br />56 MEDICAL WASTE FACILITY <br />❑ PUBLIC WATER SYSTEM <br />- ❑ OTHER (PLEASE SPECIFY ABOVE) <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. EHD wiil 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 $87.00 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 <br />TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />