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DEC. 8. 2003 2: 16Pi CONDOR EARTH TECH NO. 1691 Elid. 1NumBER <br /> DATE RECEIVED SAN JOAQUIN CO1:11M <br /> ENVMO NTAE).ALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> I)E C u 1468-3420 Fax: n j <br /> (209)464-0138 Web:www -couslehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ���bo(c 5 r_T[+ «fI1�laCEX <br /> APPLICANT:I F*T_Y. a...(''fT .��?fJZ 9uslnEssIAGENCY: r� <br /> ADDRESS: CLQ S I ` OG K-TO <br /> K FACSIMILE: �/1 ' 0 S 3 <br /> PHONr � P u <br /> TENTATIVE*APPOINTMENT DATE: �� �Time: `d <br /> �r—ry (Ploese allow t0 businr=d;,5rsiran data of applldtlon submittal _ <br /> L—I CHECK DOX TO EXPEDfTE RrOur5I{93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 23 <br /> C 1 J DATE b�-9r-L <br /> SIGNATURE OF APPLICANT �a- --�—� <br /> Department Use ONY <br /> UNIT <br /> FILE ADOREss <br /> ❑ Unit 1 <br /> � S G <br /> 2 SreMIZ IU <br /> 3. Strep I � Unit2 <br /> �- 5+� fSIrJ� �Ll il,Yl� <br /> Unit 3 <br /> C <br /> B. SIM D4 <br /> 7- StK <br /> a. S °w 12 q 22 C <br /> Unit 5 <br /> s. swot hCN <br /> / D <br /> t0. SVeat �/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 9' SOLID WASTE FACILITY <br /> �a UNDERGROUND TANK(UST)CLEANUP SITE(Lop) ❑ HOUSINGAB "ENT f 90LID WASTE VEHICLE <br /> `�,�.1 OTHER CLEANUP SITE(NON-LOP) t7 FOOD FACILITY ❑ DAIRY <br /> yr UNDERGROUND TANK(MONITOIUNGIREMOVAL) ❑ DOG KENNEL ❑ PKG TREATMENT PLANT <br /> 9Qsu3 HAZARDOUS WASE GENERATOR ❑ CHICKEN RANCH <br /> TIERED PERMITTED FACILITY ❑ MOTELIHQIEL E] PUMP ERTRUCKICATION S M TOILFIS <br /> ❑ POOLISPA E3 LAND USE APPLICATION SMS <br /> 0 TATrOO1BODY PIERCING ❑ OTHER(PLEASE SPECT <br /> o MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(S) files from the lists)oabaye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 4640138 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 <br /> confirmed <br /> ation- ed Tiles <br /> approximately five business days but no later than ten 10 days after receipt of app <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 END staff may not be immediately available for review- Anew <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 <br /> a$93.0 deposf prior expenseat the <br /> of the applicant. Future file reviews by the same applicant mayrequire <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 CONFIRMEDPHONE - FAX INITIALS. <br /> REVIEWED YES NO REVIEW DATE' <br /> Oio�a.azaas - <br /> NequoS <br />