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VJ/CJ/LVVf li 10 rnn <br />11/1b/1bn�,{lb\�4/,/�,I(+�.-•., fa002/002 <br />krvv irtuivic�vi�__w�in EHDL 3 Uj <br />t -o AN �OAQ1r;IX COi7NTY oc NUMarR <br />ENVrRONMF;NTA-L HEALTH DFFAPTmrNT <br />ENVIRMAY 2 5 MPast Weber Avenue; 3n4 Floor, StOc$ton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web.. vnvwsJBOv.prg e}[d <br />ONMENT HEALTH (r/e <br />PERMIT/SERT_}WLTC ]R C <br />ORDS RELEASE APPLI <br />CATION <br />APPLI'I T; rrw n <br />ADDRESs:_ZBZS /!/7,�r1y� r1r _ 61U91NESS/AGENCY: I2rp- <br />PHONE(1J: GD `i yIC7"-/'�y.S—` PHONE (R): <br />TENTATIVE* APPQINTMCNTDATE, 5 of f7 FACSIMILE: <br />(Please allow 10 business days Irem date appficallat submlltal • •ianfaf/ve cit 11mw <br />El CHECK BOX To EXPEb1TE REQU ( only must be cco-finned) <br />:9500 FEH GASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BU Wes" <br />SIGNATURE OF APPLICANT �f � �-' <br />DATE Z3 / <br />Electronic Info"atlon! ❑ List Map.- Dgrorlption: <br />FILE ADDRESS <br />V� <br />f� Smoot# street Name city EHD USE ONLY <br />All; vG .'oAj ►hAJ usT C>LD) Unit <br />IZ�I� Q unit z <br />$. <br />4. <br />unit a <br />5. <br />6• UnIt 4 <br />7. <br />8. ❑ unit s <br />Q. <br />1p,LL ❑ Unita <br />Specific Data Range of Information Requested li <br />From G <br />,G7 to <br />, <br />ENVAONMENTAL HEALTH DEPARTMENT FILES <br />;g�VuMbEROROUND TANK (UST) CLEANUP SIR (LOP) M HoU9Na AOATEMFNT - MS OUO WASTE FA=jTYNENtcL! <br />ER CLEANUP SIT;/t�NbN-LOP) FLFOOD FACILITY O WASTE <br />TRE <br />(M <br />NOEWROUND TAWONnpfUNOJRFMOVAL) UDOG K91N!fE�L�� ❑DAIaY <br />JULArARDOUa <br />WASTE G12NERATOR t2 CHICKRN PANQJ dWAS7LX'ATER TREATiIENT PLANT' <br />Q Tnnusn PFhlAt1'rED FACILITY❑ MalFLMOTEL <br />O PUrAPER TRUCI!/YARwaarm TDa.ETs <br />L3 TATTOWBODY PIERCING - ❑ OOIJSPALAND USE APPLicATgN Sass <br />❑ M1!010AL WASTE FAWM-Y OTHER <br />(PLFJSE SPECIFY)ff�__r/L�NTi <br />WILL AND.SEP= PERHn RECORDS ARE AVAueLe FOR REVIEW. MDNOAYJ'RIDAY B'00 AM-5'ODPM . EXcLUDNo HDLIDAYs. <br />1. List up to ten addresses in the space above, Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (2091484.0138 0 mail to tha address Indlcated above Address <br />ranges will not be accepted —for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notlfy/tha applicant If any EHD files exist. An appointment for review will be confirmed approximately tan (10) <br />days after r0Celpt of application. The files will be held for a maximum of five business days for roviow. Appointments <br />should be scheduled accordingly. _ <br />3. A file that is actively being worked on by EHD staff may not be immodiatoly available for raviaw. A now application may be <br />submitted when tho file Is available. •� <br />4. Any file not returned In the samn condition as released will be morgan lied by EHD staff at the ekpense of the applicant <br />Future file reviews by the same applicant may require a S95.0o deposit prior to review.. <br />ENO IISF nN1 Y <br />