Laserfiche WebLink
JUN—IY-200t) 16:19 CONDOR EARTH TECH 209 532 0773 P.02 <br /> tr �' OAIN JVAYUM %,VUn1 Y <br /> A,, ,-oNwNTAL HEALTif DEPARa-L•�AENT <br /> . 304 E Weber Ave 3�Floor Stockton, CA.95205 <br /> U ?OW9)468-3420 Fax: (209)464-0138 Web:www.co,san-joaquin.ca.us/ehd <br /> is WRONMENT HEALTH pUBLIC RECORDS RELEASE APPLICAMN ?Z0 <br /> APRMqff rLg <br /> APPLICANT. PAT,�9 (� _6 >7A L,c 7—B -rUSINESS/AGENCY; {4T r- <br /> ADDRESS; C�-f 663 $a,AN LANE <br /> PHONE: 2.09 3� •_4 (� l FACSIMILE; <br /> TENTATIVE`APPOINTMENT DATE: �, "AO Time: Am-- <br /> (Please allow 10 buslow days from A of appllcatlon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. street l a ❑ Unit 1 <br /> 2. streM 3 + a I _ , ,�. <br /> a. strKt I Oa Unit 2 <br /> ., suzet a <br /> s. s. u s I•i a l ve• ON /7 Unit 3 <br /> 6. Street 9'4 6, G ei <br /> 7. street S- I a Unit 4 2 <br /> a. Street <br /> -110 5 ^a <br /> 9. ie1 ('`�• ❑ Unit 5 <br /> 10" 5ueet 4 S oc k—l-o n <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES w1�t <br /> UNDERGROUND TANK(UST)CLEANUP SIZE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILrrY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY SOUL)WASTE VEHICLE <br /> UNDERGROUND TANK(MONIrORINGIREMOVAL) 0 DOG KENNEL DAJRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMUTED FACILITY ❑ MOTEUHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING E7 POOLISPA ISLAND USE APPLICATION SITES <br /> $G MEDICAL WASTE FACILITY Q 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)464.0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHO files 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 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. '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 RMEW DATE <br /> EHD 4e42-0oa <br /> atartOtll - . <br /> TOTAL P.02 <br />