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Dec • I1 . 2001 II :OBAIA CONDOR EARTH TECHNOLOGIES No•754E F . I/I <br /> °ATE��""•-- <br /> SAh�AQUIN COUNTYpUgLIC HEALT*RViCES vw wo wureucr <br /> �J ENVIRONMENTAL-HEALTH DIVISION 7Q s <br /> / 0 5 304 EAST WERrnk AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)458.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ADDRESS ri 4e, <br /> PHONE FAACCSIWLE ^ <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 tom100 hhossince days from date off aa/9oolcadon sus matuo <br /> CHECK BOX TO EXPEDITE REQUEST- 87,01 FEENREQUEST POCESS D 1N3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT T x 2 DATE _ I6 ) L t71 <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 0� <br /> ENVIRONMENTAL HEALTH DPAS(ON FILES <br /> L UNDERGROUND TANK(UST)CLEANUP SITE(LOP) U HOUSING ABATEMENT SOLID WASTE F=LrrY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> kf UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERmnTEa FACILITY O MOTEIJHOTEL 0 PUMPER TRUCKNARDICMU TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ P60LISPA " - ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILM ❑ PUBLIC WATER SYSTEM ❑ OTHER.(PLEASE SPECIFYA30M. <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)484-0138 or mail to the <br /> address Indleated above. <br /> 2. EHD will notify,the applicant If any EHD flies exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. 'The flies <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 an 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 Ufe 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$87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be,confirmed with EHD staff. <br /> 8. 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 /> pFVIFWGn Yt_C un OLlllCiMr.Y�ATc <br />