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_'__v"� iI�H"iii rHU(_ U <br />UA,I Co UINTY tnu LOG NUMSER <br />�IONMENTAL HEEL <br />Tjf 304 Easy Wcber Avenue, 3'd door, Stockton, CA 95202-27D8r <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web. wv <br />w.sjgov.otglehd <br />RECONS RELEASE APPLICATION <br />z3w!5' <br />aPPLICaNT: A 1�P�UBLJC <br />ADDRESS: i t LONE Po,�M BuswcsSIAGENCY: SSOC <br />PHONE (1) 9•S�q • Z?i�i CITY E <br />PHONE m: STATE Com` <br />TENTATIVl:R APPOINTMENT DAMZ, .Q 10FACSIMILE: <br />'101. 5 o(• 2lzz- <br />{Please anew to busirnss days frown date of <br />CHECK BOX TO EXPEOiTE REQUEST . aPDl�adan tubmgyl . • T►me: �M <br />r4teritive only -must be eonfIrmed) <br />SIGNATURE OF APPLICANT I f9a.Op FEE (C <br />O List o 1Nap • <br />C__ <br />1`. Co <br />2. t <br />ASH OR CHECK ONLY) . REQUEST PROCESSED IN f BUSINESS DAYS <br />DATE .Q <br />ion <br />END USE ONLY <br />O Unit—1 <br />s. Zz► O Unit 2 <br />�• Unit 3 <br />9. woJnit 4 <br />Ia. Dom' 0 Unit 5 <br />Specific Dater Range of Information Requested: From �-� � Unit 6 <br />�f ENVIRONMENTAL HEALTH DEPARTMENT FILES A�AII„q�� <br />UNDERGROUND TANK (US -n CLEANNI► grit <br />�O OT"ER Ur (NONITlOOIIPIN - -(L-O-P-) - O (OUSNG VA7 <br />BNErTUNDERCROUN0TANKMd F00FI:RY <br />to S OLD WAsE PAcrtYNFHICLE <br />HAUAI)OUS <br />WASTE0 Doo KEN <br />GENERATOR �REiMOVAII NEL U WASTE TIRE <br />O TIERED PERMITTED FACRITY E3 CHICKEN P kWM d DAIRY <br />Q C1MCTEUFiOt>:l WASTEWATER TREATMENT PLANT <br />TATTOOnkvy PIERCIRG C7 PUMPER TRucK7yARDlCHtmcAL. TOILETS <br />❑ MEDICAL WASTE FACILITY d POOUSPA <br />C3 OTxeet (PLEASE SP&CIFY) C1 LAND We APPLICA)ION S,TrS <br />11 I L s1 LIN �A <br />` WELL AND SE►tec pFRnaT COROY ARE AVAI�AELt root REvtFW - MONOAY RMAY 1:M <br />_ Lw. ..JJ... <br />• --� .- " o-4re4NeS In .tne space above. select thetype(s)- -•-m the -list• T - `..Kvvinv nDUDAYS. <br />appropriate bax(es). At least one file type MUST be selectedax tog 200 a64 093(3 ob malbt che <br />the ki drthe <br />ess <br />Indicated �bovP Addross ranges will not be accepted --for additional assistance with fife addrQssed contact <br />the EHD. Applications received after 3:00 pm will be processed thsa next business day. <br />2. The ENA will notify the applicant if any END files exist. An appointment foot review will be confirmed <br />approximately ten (10) days after receipt of>;sppiication. The files will be held for a maximum of five business <br />days for review. Appointments should be scheduled accordingly, <br />3. A file that is actively being worked on by END staff may not be Immediately available for review. A new <br />application may be submitted when the file is available. <br />4. Any file not returned In the salve condition as released will be reorganised by END staff at the expense of the <br />applicant. Future file reviews by the same applicant May require a393.00 deposit prior to review. <br />Eke 44.04 <br />lo/nll?"6 <br />