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AUG. Ll. LUU4 4:4UNM CONDOR tANIH ItCH � N0. 6355 P. 1 <br /> DATE RECEIVED <br /> SAN JOAQM COUM EHO LOG NUMBER <br /> EN'SrIRONMENTAL HEALTH DEpARTMZNT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> AUG 2 7 Z090)468-3420 Fag: (209)464-0138 Web: "WW.CO-San joaquin,ca.uS/ehd <br /> Ef 'VMENT HEALTH PUBLIC RECORDS RELEASE APPLICATIONI- ` <br /> CANT: 4X, "--' L5 9VSINESSIAGENCY: �lc �f1Jt/tp�0 I'CS ..I VtC. <br /> ADDRESS: 8 a 5 k <br /> zo <br /> PHONE: FACSIMILE: <br /> TENTATNE•APPOINTMENT DATE: /0 S¢ as tr J00 Time:— 3o AM <br /> (Please allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-03.00 FEE-RE' EST PR CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT -C <br /> DATE 15 Z* o <br /> C/ Oepadme Use Only <br /> FILE ADDRESS UNIT <br /> sues a <br /> z sues <br /> ❑ Unit i <br /> V< 3. svee 24 a1 U Q- I-fo <br /> /. 9uea - G It 2 <br /> ✓,/✓ _5. S <br /> ee <br /> a suer ! L Unit 3 <br /> l o A <br /> all pis ' sm <br /> a sues I t R c c 5 � Unit 4 <br /> a, su9� <br /> m 0 <br /> G ❑ Unit 5 <br /> 10. Suer � L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIL-w <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 12 HOUSING ABATEMENT CC <br /> �y OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE FACILITY <br /> y�UNDERGROUND TANK(MONITORINGIREMOVAL) In000 KENNEL SOLID WASTE VEHICLE <br /> HAZARDOUS WASTE GENERATORO CHICKEN RANCH DAIRY <br /> TIERED PERMITTED FACILITY 0 PKGTREATMENT PLANT <br /> O TATTOOIBODy PIERCING O MOTELIFIOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> C3 MEDICAL WASTE FACILITY - -� POOUSPA -- ---- ----O-LAND USE APPLICATION SITES—-- - <br /> h <br /> OTHER(PLEASE SPECIFY) <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)464-0130 or 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 confirmed <br /> appy wimatety 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$93.00 deposit prior to review. <br /> 5. 'TENTATNE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 Pm will be processed the next business day. <br /> 'f7 Eb;APF oCN77 iE';, <br /> lui dNFIRM <br /> t7R' - <br /> FAX <br /> I .,.' 4T <br /> `vt <br /> R�1�W1*q i <br /> vot2m `0 1319 AjajI`/vv1 G,57 iS cr, D,A. rctje. <br />