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DEC. 8. 2003 2: 16PM CONDOR EARTH TECH NO, 1697EHEF: !NUMBER <br /> DATE RECEIVED 0 SAN JOA.QUIN COUNTY 0 _ <br /> FNvrRONMENTAL HEALTH DEPARTM NT <br /> ' 304 E Weber Ave 3'd k1Dar Stockton, CA 95205 <br /> UEC 468-3420 Fax: (209) 464-0138 Web: www.co.SaD-Joaquin.caus/ehd I <br /> PUB <br /> LIC RECORDS RELEASE APPLICATION <br /> I LJ.M1` ��)baR 15-A PT <br /> APPLICANT: <br /> Ft �1'F`LAG" BUSINESS/AGENCY: n <br /> T c�E S i ` Toc KTolj <br /> ADDRESS: <br /> PHONE�� FAC�StIMILE., <br /> TENTATIVE-APPOINTMENT DATE: c2C�- Time: ��� _. <br /> : _ <br /> (Plnase allow to buslncss dols from dare of appllratlon submiUal) <br /> HE <br /> ❑ CHECK BOX TO EXPEDrrE REQUES 93.00 PEE-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT "� DATE �3 <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> I, suedSt p unit 1 <br /> V <br /> s� Sy. c' . 2 <br /> k e. svKrI q$ <br /> V ct �lJnit <br /> .K 0. S 10-72. <br /> ,r a srra o �I � �, _ � Uni <br /> X s. swat O <br /> 10. SVe d b <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> D FOOD FACILITY SOLID WASTE VEHICLE <br /> OTHER CLEANUP STYE(NON-LOP) ❑ DOG KENNEL CI DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 CHICKEN RANCH ❑ PKG TREATM[:NT PLANT <br /> HA2Aft0ous WASTE GENERATOR ❑ MOTELfHOTEL t] pUMPERTRUCKIYARDIC M TOILETS <br /> TIERED PERMITTED FACILITY P POOL/SPA ❑ LAND USE APPLICATION 5 <br /> D TATTOO/BODY PIERCING D OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(S)of files from the ILst aboye,_.y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 4640138 o mail to the <br /> address indicated above. o.n1m nt for review will be co firmed <br /> 2. EHD will notify the applicant if any EHD files exist- An aPP <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 shheduled <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 reorga §93.Oby HD staff <br /> t the expense se <br /> of the applicant. Future file reviews by the same applicant mayrequire <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 /> DID 4542-006 . <br /> 52rS00t <br />