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MCILRATH VALLEY TANK PAGE 0L <br /> 06/17/2007 22:30 2094750620 - <br /> L <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENv>RONMENTAL HEALTH DEPARTMENT /� <br /> 600 E.Main Street,Stockton,CA 95202-3029 (rill <br /> Telephone:(209)468-3420 Pax:(209)464-0138 Web:www'490Y.org e <br /> IS <br /> PUBLIC RECORDS RELEASE APPLICATION r 1A�f <br /> APPLICANT: /1411 %JL r.f`f /I r{-f _BUSINESAIAGENCY: <br /> ADDRESS: f tj <br /> PHONE(1): f717• 6 y9 8 g r6 PHONE(2): y FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: <br /> r Ti". ✓ <br /> (Please allow 10 business days from date Of 3PPH 00111 Submittal--Tantathno only.must be Confimlod) <br /> ❑ CHECK BOX TO EXPEDITE REQUIE T 95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED INl3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE b7 0 <br /> ElectronicInformation: ❑ List❑ Map-Description: <br /> FILE ADDRESS MND USE ONLY <br /> Street III Street Name Clty /y,C ❑ UNti <br /> 2. <br /> 3. unit s <br /> \� 4_ \� <br /> S. <br /> ❑ Umt4 X <br /> 6. <br /> 7 ❑ Units <br /> 8. <br /> 9 ❑ Unite <br /> 10. <br /> Specific Date Range of Information Requested:From ��Q�i h to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 13 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING AaATE11ENT 0 SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑WASTE TIRE <br /> jilpNDERGROUND TANK(MoNnORINGIREMOVAL) 13DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR 171 CHICKEN RANCH ❑WAETEwATER TREATMENT PLANT <br /> •TIERED PERMITTED FACILITY 0 MOTELIHOTEL Cl PUMPER TRUCKTYARDICHEM TOILETS <br /> ❑TATTOOMODY PIERCING ❑yP,000SPA Oji"/ry-- DUSEAPPMATIONSITES t fQ <br /> Cl MEDICAL WASTE FACILITY -WOTNER(PLEASE SPECIFYIIA,-%-- r� [10 � f -"" -s <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW. MONDAY.FR0AY9:oo AM-6o0PM - ExCLUmNo HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the typs(s)Of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address Indlcatod above- Address <br /> ranges will not be aeceptad—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 ten(10I <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately avallable for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned In the same 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$05.00 deposit prier to review. <br /> EHD USE ONLY <br /> Roar-os w.c <br />