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DEC. 8. 2003 2: 16PM CONDOR En'RT- TECH N0. 1697EHTP. ]NUMBER <br /> DATE RECEIVED . SAN JOA.QUIN COUNTY • <br /> I' h' ENV oNMENTAL HEALTH IDEPARTMENT <br /> 304E Weber Ave 3rd Floor Stockton, CA 95205 <br /> 468-3420 Fax: (209)464-0138 Web: www.cOsaLt joagTun.ca us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> ��^^ ,I ��bof� �fll✓TH T4INoc � <br /> APPLICANT: �i—h`r� ���^.�CZJ�-�G�Z— eusmEssrAGENcr: Cis <br /> ADDRESS: 15 GGA S I 5�OG f�"V-� <br /> PHONE( A r>i. U I FACSgIMILE: O S 3 <br /> TENTATIVE*APPOINTMENT DATE: O�CZ g- i 0 Time: <br /> 4.- <br /> (PlDase allow 1D business dapsfrom dace of application submittal) _ - <br /> V � <br /> El <br /> CHECK BOX TO EXPEDITE REQUEST.--$93.00 FEE-REQUEST PROCESSED IN 9 BUSINESS DAYS y, <br /> SIGNATURE OF APPLICANT C t tJ DATE I car �3 <br /> Department Use Only <br /> UNIT <br /> FILE pDORESS <br /> s 3f ❑ Unit 1 <br /> z shen s - ° G J <br /> 2 1Z�' <br /> 3. gen I b �✓/) �\ <br /> Qri'7 ° 3 1 / <br /> j 5. ShM I p <br /> ri 7 ft d ❑ <br /> P64UUIt <br /> -� <br /> e. Sen <br /> � Unl <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT Qt�T SOLID WASTE FAFILITY <br /> 4% <br /> OTHER CLEANUP SITE(NON-LOP) " U FOOD FACILITY �I SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 13 MOTELIHOTEL r] PUMPER TRUCKIyARDICH M TOILET$ <br /> TATTOO/BODY PIERCING P PO4OLISPA ❑ LAND USE APPLIcAT10N SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) /f <br /> 1. List up to ten addresses in the spade above. Select the type(s) of Files from the list abayeJby checking <br /> the appropriate box(es)- At least one file type MUST be selected. Fax to 209 4fi4 0138 o mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist- An appointment for review will be co firmed <br /> approximately five business days but no later than ten (10) days after receipt of appliea on. The files <br /> will be held for a maximum of five business days for review. Appointments should he 4heduled <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 /> DID 4342-06 _ <br /> NN;007 <br />