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JUN-IY-20175 16:19 CONDOR EARTH TECH 209 532 0773 P.02 <br /> I ��(� �J (�; 3A-N J VAyUM %—UU1V 1 x <br /> U� ECE �J �V EN ilRONWNTAL HEALTH DEPAR'TI4,�kNT <br /> 304 E Weber Ave P Floor Stockton, CA,95205 <br /> 0 ?QY9)468-3420 Fax. (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ZiMRONWENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: PAT�� 6 2 7 e, _c Z _6USINESSIAGENCY <br /> ADDRESS:_CZ,16&3 'Be,,qN (..ANE <br /> PHONE: FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: 0200 Time: <br /> (Please allow 10 business days from I.of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS U r■ <br /> �13 <br /> SIGNATURE OF APPLICANT DATE ^ <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I d [) Unit 1 <br /> 2. &rw 3 atv <br /> 3. s-et I 2f,0 Oky Unit <br /> 4. S"e I A City <br /> s. svee� u s ►i ve• oty 3s— 9.4 5, o. a /Unit <br /> �r <br /> 7. steel s- I PaJw Ave. a ;pt<Unit 4 <br /> e. sat 710 5 a. <br /> s. s,r.« 20,0 W. ❑ Unit 5 <br /> 5 oe,"o, VO I <br /> �et <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 11 HOUSING A9ATEMENT SOLID WASTE FACILITY <br /> e/ ❑ FOOD FACILITY SOUR WASTE VEHICLE <br /> ❑ DOG KENNEL 9e DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 1 pL ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHFM TOILETS / <br /> �a I ❑ POOLISPA FC-LAND USE APPLICATION SITES (� <br /> C3 OTHER(PLEASE SPECIFY) 111 �B <br /> Ice above. Select the type(s)of files from the list above by checking <br /> Ine file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> ` EHO files exist. An appointment for review will be confirmed <br /> ` but no later than ten (10) days after receipt of application. The files <br /> U `�{ business days for review. Appointments should be scheduled <br /> 7 7 on by EHD staff may not be immediately available for review. A new <br /> 7 n the file is available. <br /> ondition as released will be reorganized by EHD staff at the expense <br /> rs by the same applicant may require a$93-00 deposit prior to review <br /> ust be confirmed with EHD staff. <br /> o. Hppllcaxions receives aTier j:uu pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> [)ATE CONFIRMED PHONE FAX' INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> oen to.02a06 <br /> a&2003 <br /> TOTAL P.02 <br />