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Paul Robinson Fax: (818) 296-9499 To: Fax.: +1 (209) 464-0138 page 1 of 1 0510912016 9:24 AM <br />EHD LOG NUMSER <br />SANJOAQUIN CowiA'r*,,, <br />LIQ F. C -,o- EN E D, <br />Efate R0 NUIENITAL HEALTHDEPAPMMEENT <br />14 A Y 0 9 2 0 � 6 1868 East Hazelton Avenue, Stockton: CA 9.5205-62a2 <br />Telephone: (2031461;-3420 Fax: (209) 464-0138 Web: v4'v%w.sjgo%r.org(ehd <br />7WIRONMENTAL HEALTF! PUBLIC RECORDS RELEASE-: APPLICATION <br />A PLIC A; NOT T Prh) i 0 BUSINESVAGIPENCY: <br />ADDRES& CITY1553-TATEIZIP: <br />PHONE (11): <br />62 -70,y- FAX OR E:41411.., <br />Please allow 10 business days from date of appificaffen submiffal for the records to Sc ava.flable. <br />,Wff: vAll cofftact you to arrange art + appointment daie and €h -aa ILD rakriewthe requested racordsL <br />cy $1.30 Er-E.'.(CA C <br />A <br />RE <br />SIGNATUOF APPLICANT DTEA .�'; /�' <br />1. Lilsstinto ten addresses Irk the Space Wow. Selecttha type(s) of fileS from the list, beim v by checking the appyopriate <br />box,'"). Atleast one file type ITIUST basefected. Fax to the addrims hid5cated above. Address <br />ran <br />ps t"All not be accepted. Applicallarts received after 3:00 pri t#vtiff be. prot, ed %Le next busifness- day-, <br />2. For assistance, in Werffffying the nelature and conterA & EHD mccords, pfeas-e --orita-,t EPD at the number noted above. <br />3. The G -FUD will nolti'Lyr 1&ta 2prU�am. I any EHD rUes. exist. A n appoirdstw�:r:A L.'02, review wiflibia conflanned approximaAely tert (10� <br />days aflter receiv, of applicatiom ��m files mialf be held, for a maximum of five bw-timass days for rekliam Appotntments <br />si-ould be scheduled ar-cording-ty. <br />4. Any file not rate rned In. the Same conditiort as rel-easeded-111 be reorganized -by ERD at theepense of the applicant. <br />t:uturq file review -s b'Y' ihe San, e apant m <br />plicay requa ire S i 30 depost prior to reldevir, ' <br />VVELLAINDSETIC PEW0.,1T RECOR DSARE AWMILABLE FOP, REVEWI: [!tO-NDAY-FRI+.DAY�-CIOA!igf'+-5:03;11 <br />triformattan: E] List [] Nft-ip — Description: <br />Specific Defs Range of Irdan-taf-w Requesto-d: <br />-MEN <br />(MAL OfAiRtMEWT <br />RLE ADDRESS <br />F <br />Earr HD USE ONLY <br />TA.xx (UST) <br />Street game <br />City <br />CLEANUP SITE= (LOP,) <br />! <br />OTHER CLEANUP SITE (Noh-LOP) <br />C' <br />[54-11ZARMLIS bVASTE <br />j JITIERED PERMITTED FACILMY <br />� J. ABOVEGROLIND TANK <br />i <br />0 pvvs <br />&UST (Moi%mf�iNGIREmOvALI <br />MHAZARDOUS WIATEMALS <br />SPILL11RELEkSE RESPONSE <br />4 <br />EKWATER QUALITY <br />SOLID WA13TE FAciu-ry I VEHiC:L-- <br />FOOD FACILITY <br />POOL / SPA <br />'kA <br />DAIRY <br />c5—m� (AW" <br />rl LAND USE Ar-PLICATKW SITES <br />0 <br />Fj SEPTIC PUMPER Tpaucy. <br />YARD I CHENMAL TOILETS <br />WASTEWATEP. TREATMENT PLANT <br />HOUSINGABATEMENT <br />Ft4pTEVYATEL <br />_, <br />g. CLIPA - KAZ4JAT <br />cmimn RANCH I Daoas KEN1mFL <br />MEDICAL WASTE FACILITY <br />0 TATTOO/BODY PIERCING <br />R2�souo wmz- <br />WASTE TIRE <br />Ej GOWLAINT <br />E <br />I <br />E] AmouNrwci; <br />CrNiER(PLEASE SPECIFY): <br />u <br />1k <br />""-;z0XE D AREA- EHD USE ONLY` <br />M RZe <br />eceived Time—May, 9,-2016— 9:25AM—No,0782 <br />