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iclvYj VVo 14v rnn16002/002 <br /> 11/1 <br /> &�9-WEP)�1 <br /> ENVIRONMENTAL I* rHOG ul <br /> SAN JO.A.QUIN coum EH:)Loi NUMBER <br /> f j F 4 4 2006 ENVMONMNT,AL MALTH DEPART1V ENT <br /> _ 304 Fast Weber Avenue, P Floor, Stockton CA 95202-2708 <br /> � UNNIENT H%jjj&one;(209)468-3420 Fax: (209)46"138 Web:www.�gov.org/oh <br /> ERMIT/SERVICES <br /> PU33LIC RECORDS RELEASE APPLXCA.MN <br /> APPLICANT. Z Ca 5: i;, �l�b7J 11U9lNEBSIAGCWY! f <br /> APDRESSi 5 �' Al Y1Z7l G= 57" <br /> PHONE(1): PHONE(x): - -�— FACSIMILE: _ q`t 9-06;t) <br /> TENTATIVE*APPOiNTAMNT DATE: Time: - <br /> (Please 011*w 10 business day$from data of application submltW•,Antabve only-must pe corlfirilloo <br /> b CHECK BOX To EXPEDITE REQLW.$T-596.00 FEE(GASH OR CHECK ONLY)-REQUEST PROCESSED W 3 DUSMESS DAYS <br /> SIGNATURE OF APPLICANT rQ# <br /> Efectronic Information: ❑List❑Map-pescrlption: AAZ&-L21_j1' TO <br /> FILL ADDRESS EHD USE ONLY <br /> Stroat# Street Name City V_nit 1 <br /> ?60 m s o d <br /> 2. Unit 2 <br /> S. <br /> 4, Unit 3 / <br /> 6 *VUnit 4 <br /> O Unit s <br /> 8. <br /> 9. unit B <br /> 10. - <br /> Speoiflc Data Range of Infonnation Requested:Eram to <br /> ENYIRONMENYAL HEALTH DEPARTMENT FILE$ <br /> PO UNeER6Rwmh TANK(UST)CLump SrrE(LOP) 17 HQVSM A 3ATF AWr P(SOLID WAs-m FACBMNEIVAI <br /> Oar!R CLP-ANUP Srra(NbN4_O?) 13 FOOD FACIlM 0 WAS12 TOM <br /> UNoimC;iwwm TANK(MoNITvAiNGIREmaVAL) C Doe Karo, A DAP9Y . <br /> Pk HAZA :PUS WASH GENRR lTOR W Ctuauan RANCH W AsTEwA•r1;R TREAnm"T PLAW' <br /> O T11RED PE7UWAM rACU1Y E3 MOTEL/m7a PUMPER TRuc1VTAWCHEm Toners <br /> C3 TAWOOMOOY P1QMG ❑POOLISPA I LAND USE APPLICATION&TES <br /> L7 meoic"WASTE FAcmv 0 OnIER(PL'CA 9 SPECIFY) -- <br /> Wsu-AND SEPTIC Pmmrr i Rcons ARE AYAn,ui,a rOR REVIEW- M0e111AY-17-woAT 6:00 AM-5:00111 - ExctuOwa HOLMAM <br /> 1. List up to ton addrasse6 In the space above. Select the type(S)4f files from the list abovo by checking the appropriate <br /> • box(es), At least aria flle type MUST be aelaetsd. Fax to(2091464-0138 or mail to thn address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addreti0s,contact the EHA.Applicatlons received after <br /> 3:00 pm will be processed the next buslness day. <br /> 2. The 5ND will nodfytha applicant if any Ei4D files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maxIMUM of ITYo businass days for raviow. Appointments <br /> should be scheduled accordingly. <br /> 3. A,file that is actively being worked on by EHD staff may not be immediately available four review. A new applicxd1on maybe <br /> submitted when the fila isL available. <br /> 4. Any file not returned in the:same condition as niea5ed will be reorpanixed by E141)staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review., <br /> EHD USE ONLY <br /> HP 4e-06 SOoos <br />