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11/28/2006 10:59 131079f.11 PAGE 01 <br /> bMERtlE 5 2994540138 ENVIRONMENTAL HEALTH PAGE 01/01 <br /> 1i'14,Y, LJtnu was nuMne:n <br /> SASE JOAQUIN COUM <br /> u 2 S 2006 FNM0rrWyrAL M&LT z MARTMENT <br /> ENVIRaPIMENT HEALTH 304 Bag,Weber Avernus, 3"d Floor,Stockton,CA 95202-2708 <br /> ?ER LAMENT HEAL Telepholae:(209)469-3420 Fax:(209)464-0138 web:www ajbwv ory/chd <br /> 5 70 <br /> PUBLIC PT CORDS RELPA.SE a3. )?L1CATXdOj <br /> APPLfcANT: 4 W :"1n sUSlxEssdAGENCY: -- <br /> ADDRESS: 00 ' <br /> gYiT_:3+u <br /> - <br /> PHONE(1): nkF` 434a0C PHONE(2): rACSIMILE: <br /> TENTATIVE*APPo1NTMENTDATF; /a/ O Time: <br /> (pit=*avow TO busir"s days from date of application r0mittai•-TerrfA only-must be conarmed) <br /> O CHECK OOX TO 9WEDI IE REGNEW 595.00 rE (CMH R CHECK UNLY)^REQUEST PROCESSED IN 9 BUSIN 99 MYS <br /> SIGNATURE OF APPLICANT r �n�A�7 DATE n <br /> PJ'ectronbe Information: ❑List❑Map—Descr)ptlon: <br /> FILE ADDRESS EHD UE ONLY <br /> Street# ffifraek Nano Cty ❑ Uah i <br /> 1. rj0.✓t tJfr12>t^� a 40-^ rNov 2 <br /> 2. —I i t t t �sr Q unit s �\ <br /> 3. UnR 3l 1 <br /> 4, 2Z UJ aaer�oo L� sr <br /> 5. J) D UnIt4 <br /> s. . G/ <br /> 7. 1Rs <br /> 8. <br /> Ihia6 <br /> to <br /> �a <br /> spRciflo Data Range of Information Requested:From 0.�\ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> to sauPwASTe PAcatryrvt:TaaE <br /> ZUNojjRGPAUNOTANK(UST)CLEANUPSrM(P) 0HoWR7GARATERPM --4,0010 <br /> E2 r0M FAMMY d WASTE Tate <br /> RFOTHER Cwxw S=WON-LM o Doo Kr�IxFA 17 DAIWY <br /> �UNDEfioltoTlNo TANK(MONROTatICfltaA10VA1.) 17 PiHICm RANCH wASTrwATsRIPAATWRT PLANT <br /> HAZARCOUS WASTE C.ERERAtOR ❑MOTMIMM4 QMiMP£RTRii4TWAiDA".ilEM To"TS �\ <br /> RIMMM PEIWAttao FACLFrY ❑POOLISPA 13 LAW USE APMJCArAW SrES <br /> 0 TATTOOMOOY PoxaHo - - O OTHER(PLGASE SPSPIFY <br /> ❑MGM&WASTE FACA.ITY <br /> Welk AHC SEPTIC pFauiT Rsconox ARE AVAIL01 FOIL R6'VItaS • MotAAY-FRICAY 8:6Cst eboye - Checking the Appr <br /> I. List up to tan Addresses in the$pass above. SRlact the type(s)of fills from thetesthe address Ird➢Checking the <br /> ab2r Address <br /> box(es), At least ono file typo MUST be selected. F <br /> ranges will not be accaptod-for additional assistance with file addresses„Contact the EHD.APplbcabivns received agar <br /> 3:00 pm will be processed the nett business day. be <br /> 2 The EHD days W%rYreceipt of application. The file$w@ be hEHD file' eld four a meeximure of five nb s n business days fm confirmed <br /> pAlrPointDxints (10} <br /> should be scheduled accordingly. <br /> 3 A file that is actively being worked an by EHD staff may pat he Immediately avagable for review- A rtew application may be <br /> submitted when tho filo is available. <br /> 4. Any file not ratumed In the some condition as released will He reorganized by EHD staff at the expense of the applicant. <br /> Future fila reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> cno tie•a6&7 <br />