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Sep . 4. 2003 12 :43PM COND.QR EARTH TECHNOLOGIES No•4879 P. 1/1 <br /> DA]C KCI.ClVCIJ =U�tsG NUM ? G <br /> ..� SAN JOAQUIN COUNTY � <br /> `�� �_l ENVI:RONMNTAL HEALTH D"ARTIVIFNT <br /> 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> SEP- 0 4 2x91)9)468-3420 Fax: (209)464-0138 Web:www.co.sazt joaquiv.Ca us/ehd1.q10 <br /> ; <br /> 'Wil'4 'HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> -lull <br /> APPLICANT: �S "'b[�A)Z-A C�� BUSINESS/AGENCY: 0 O Fe' 9_ F!T Jj� Oio <br /> ADDRESS: <br /> Tom F�To <br /> PHON 2 >~: 34 <br /> 0 S�3 <br /> TENTATIVE;APPOINTMENT DATE: i �JY yo[)+ Q3 Time.- <br /> (Please <br /> ryme;(Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUES�.SH3.00 FEL--REQUEST ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT CC�� DA-re <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I. s O W• orc ti ci C•1: `_ oN [j Unit 1 <br /> 2 V. r. C <br /> Y.— <br /> _J. a"et t d ISt . a Unit 2 ' <br /> � <br /> ,►son/s.L„iv,c�jt�.� �J�C✓;;.:/ <br /> s. s [ ' Unit 3 <br /> SA-_1A �J <br /> 7. blCt 1 f cr 55 nit 4 <br /> e. sa,et D L vt •t G <br /> s. So-.a a!X nit 5 <br /> ,a. s <br /> 7S" <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT & SOUD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY %f SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) CI DOG KENNEL 17 DAIRY <br /> Qd'HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 17 PKG TREATMENT PLANT <br /> �f TIERED PERMITTED FACILITY o MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> C7 TATTOO/BODY PIERCING 0 POOL/SPA 1,LAND USE APPLICATION SITES <br /> MEDICAL WASH FACILITY O OTHER(IP'LEASE�SPFrscv% <br /> 1. List up to ten addresses in the spa I I st aboye py checkin! <br /> the appropriate box(es)_ At least o ` 1-0138 or mail to the <br /> address i dreatgd above_ / <br /> 2. EHD will notify the applicant If any I be confirmed <br /> approximately five business days 1: jpiication. The files <br /> will be held for a maximum of five t be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked lie for review. Ane <br /> application may be submitted when <br /> expens <br /> 4. Any file not returned in the same co staff p therior toorevie�"revi <br /> of the applicant. Future file reviews posit p <br /> 5. `TENTATIVE appointment dates mu: <br /> 6. Applications received after 3:00 pm <br /> CONFIRMED APPOINTMENT DATE. <br /> DATE CONFIRMED <br /> REVIEWED >. YES NO REVIEW DATE' <br />