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- i f <br /> 16�7liTF1�Ar. 1d-c t1R 49491-48 ENVIRONMEhITAL HEALTH PAGE U1 <br /> r f J i ✓ • SAN JOA,QUIN COUNTY <br /> I ?) ENVIRONMENTAL HEALTR DEMTMI NT <br /> 904 East Weber Avenue, 3"Floor, Stookton,CA 95202-2708 ll <br /> TdOpticnei(209)468-3420 Fax: 4-0 <br /> (209)46138 WON WWW.ejgov.org/c 7 <br /> PMUC IRECORDS RELEASE"PLICA.'KION <br /> APFL(G4NT: )� h/�� I �7 ,,B••U''6n11N'96,tdIIAGr:KCy:-'�p�C,c C-`'°"v")-- NTS <br /> ADDRESS:.2Soo CA f�W I�/A U--O /.�� �VV7�tWvy f ckceL Gf�7S,p� <br /> PHONE(•1); a 57S_ ggAI`2� PHONE(2): PACSIMILV;,g?r>`��H,�,,(�CJ <br /> TENTATIVE"APPOINTMENT DATE: G - 3- ,o Time: AM <br /> (Please allow 10 business dep from date of appliOallon submittal-^Tentative only-mucl be confinned) <br /> C] ¢HECK sox TO E)(PEDDE REQUEST-$95.00p 11 OK ONLY),REQUEST PROCM0 IN 9 USINEss DAYS <br /> siGNATURE OF APPLICANT DATE 22 <br /> Efectronte information: ©List❑M -Deoorip(ion: <br /> FILE ADDRESS END USE ONLY <br /> Street 0 Street Name City ❑ Until <br /> �• -i5O W aG 7(s usT ern t Iw <br /> 2 ❑.unit 2 <br /> G 2 <br /> 3 ;Poll <br /> 7 VISA 1e C) - El unit s <br /> s. ossrbl� Gc. f46T 1 <br /> O C- <br /> Units <br /> Specific Data Range Ot Informutlon Requested:Frolil <br /> ENVIRONMENTAL HEALTH DEPARTMENTFIL)PS <br /> .1.UHDzRORouMTAmc(UST)CLEANUP"(LOP) Ll HOUSwn ADAYRIA"T S4 SOLID WASTE FACILTYNENK(T; <br /> )p -� <br /> Ott ER0.FA W Sn(9*H4.0P) E3OD FOFAtpuTY O 4YAMTM <br /> UNOaTANKN <br /> GRCoal) � a N-1tU0011SWST11GENERATOR RACH 0 WA'Te*ARRATMMT FAT <br /> GTw=PkM=FAcMm <br /> t7M07E11Ha161 CT PUMP2RTRAUCWYAAAIG118MTUSErs <br /> OTATT001900YMERCM --e <br /> r O�PooUtim n LARnV5ti,r�PPIxP, N�1'�5�—T� <br /> M Mcvjt; LWASTE FAtdM M0711�+1(PLaAeaOeECIPY),,, ll� �►'¢A UNCI 7Qj� C91� N�C_ <br /> WeL-AND SEPTIo pgp=FtECURD3 ARE AYAILAuLEFOR RCVO W- MoNOAY-Fa=AY D:DO AM:"0PM - E%CLUMO HOLMAYi <br /> I. List up to ten addresses In the space above. Select the types)of flies from the list above by checking the appropriate <br /> bax(es}.. At least one file type MUST be roleetod. �,�.2pA 494-0138 or meh to 1hA address IP�ieatad shove Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Appfieations received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any EHD Bios exist, An appointment for review will be confirmed approxbnatetyteh t10) <br /> days after receipt of application. The files Will be hold for a maximum of five business days for review. Appointments <br /> should ba sehadulad accord rigly. <br /> 3. Afile that Is actively being worked on by EHD staff may riot be Immediately avallab(a for review. Anew application maybe <br /> -submitted when the file W available. <br /> 4. Any file not returned In the came condition as released will be rsn aanl:ed by EHD Staff atth0 aXpense Of the applicant. <br /> FUWre the reviews by the Santa applicant may rmqulre q$95:00 deposit prier to review.,, <br /> EHD USE ONLY <br /> 3a — <br /> Z9 39Vd S1Nvi-inSN00 I3V 968ZPP69Z6 9Z :T9 L00Z/ZZ/59 <br />