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MAY -28-2089 15:15 Tetra Tech, Inc. <br />415 974 5914 P.02 <br />DATE RECEIVED SAN JOAQUIN COUNTY Etas LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468- 0 Fax: (209) 464-0138 Web: www.Sjgov.or <br />43 <br />PUBLI CORD RELEASE APPLICATION <br />APPLICANT, _ Y11i11 ?.t a 16,0/-- tl SUSINESSIAGENCY: JtrL' [ l <br />ADDRESS.I`oD C� �i7T ��C 50CltylStatef2ip �C�YI f�YD-�Ll`a!C � � 11 Ai 05 --- <br />PHONE (1). 4�i'553 i tJ ?>Z �(R� PHONE (21: 41 ' 1,j I Z ZJ FACSIMILE; <br />TENTATIVE` APPOIN7TNENT DATE: Timo: IQ X1'1 1 <br />(Pleas® aliow io business days from data of appticatlan submftW1-'T006iivc onhr - must be Confirmed) <br />M CHECK BOX TO EXPEDITE REQUEST • $ OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 1,17) <br />Electronic information: [] List ❑ Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />Streets Street Name I City <br />2, it z <br />_--- - -- - <br />3. <br />4. l � Unit 3 <br />_,_.,.. -- .,, .� _.._._.-_....__.........,_..--—..... .... ...... ........... .........._� .. ..... Unit 4 <br />7 I _. ❑ Unit 5 <br />t... _......... <br />__.._-......--.._..__...._.._......,.. -----.._....._..,,,....._......._.. <br />S, i <br />i unit <br />1�. ! <br />Specific Date Range of Information Requested: From � � 00 to rzS.e.Yt� <br />b �r`5to,/- <br />4 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITYIVBHICLE o 2 <br />jXOTXER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY WASTE TIRF <br />UNDERGROUND TANK (MOHITORINGIRUNIOVAL)pe ❑ DOC KENNEL 0 DAIRY �� /D� <br />SC HAZARDOUS WASTE GENERATOR S'\ 0 CHICKEN RANCH �WASTEWAT.RTRrATMENTPLANT <br />X TIERED PFAMITTEO FAf•IIJ-No( ` M MOTELII' %0L © PUMPIIR TRUCK/YARD/CHEM TOILETS <br />Q TATTOWBODY PIERCING M POOLISPA LAND USE APPLICAYION SITES <br />MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY)_— <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLF FOR R>:Wt W - MONDAY-FMI)AY B:OO AM-5:OOPM - EXCLUOINO HOUDAYS. <br />1. List up to tan addresses In the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At feast one file type MUST be selox bed. Fax t4 (209) 4642738 S?r mail tp the addreas itt icatod above-_ Address <br />ranges w)11 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 notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ton (10) <br />days after receipt of application. The tiles will be held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3. A'Me that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br />submitted when the file is available. <br />4. Any file not returned in the some condition as released will be reorganized by EHD staff at the expense of the applicant <br />Future file reviews by the same applicant may require a $105 deposit prior to review. <br />EHD USE ONLY <br />ENVIRONMENTAL, HEALTH DEPARTMENT FILES <br />?i ii 1�0�oz3�o? ��pdo�2�2 CQ,9D0`i-N3. (.)y6V`l Y wadUsl I <br />g104J�g J - P 11ROS R EASE APP F FZ <br />C0 D090,912, .cv©nolo( (8; Uark 6 O(o 1 toBOq SF ©�D ��l9 co 00/1 TI Si W 49 �ZJ'r <br />ts2(o� OD (91 (D COxI?Ol4 Z i6oD203�4� CD�a uU i CD4DL5KN(0 <br />(.ODDI � (A 4 r S� r ( <br />Wr �Zb� SI, TOTAL P.02 <br />