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-'SEC. 112005 1 03PM CRUOR EARTH TECH �� �0, 4712 '. 2 <br /> l �I <br /> DA R�ECElVED SAN JOAQUrq :TFk!'1A NUMBER <br /> NTY <br /> EN4'3ROYYMiVTA G HEALTH DEPARTMENT + <br /> 304 East Weber Avenue, 3r"Floor, Stockton, CA 95202-270$ <br /> E +l��hUi),triCi'1 i l,fL�jf1cphone:(209)468-3420 F2x: (209)464-0138 Web: www.sjgay.orglehd <br /> 9 <br /> RERMIT,`S.EER liCE <br /> PYJET.IC RECORDS RELEASE APPLICATION I <br /> APPLICANT: Ar rvi r..-1 BUVNIESSIAGENCY: � <br /> ADDRESS_ <br /> PHONE(1)= Z - OSS PHONE(z): ftp! FACSIMILE: ` ®��8 <br /> TENTATIVE'APPOINTMENT DATETime: <br /> (Please atlaw 10 business days from date PP on submittal-'Tentative only-must be confirmed) <br /> CHECK Box TO Di E UEST-$83.00 E A CK ONLY)-P QUEST PROCESSED IN 3 B SI 'AYS - <br /> SIGNATURE OF APPLI 17AT1= <br /> UNIT DISTRIBUTION a U41 b UnA2 13 Unr Q uni-to, ❑ Unit d I3nit6 ❑ Other(aiectroriWlis�JmapS) <br /> FILE ADDRESS EHD USE ON Y <br /> Street# Street Name CRY <br /> . '. Aft <br /> 4 <br /> *'94 <br /> 4. ` ON <br /> 5. <br /> 6. <br /> 7. <br /> g i <br /> 8. <br /> 90. � <br /> Specific Date Range of Information Requested:rrom <br /> �J/ <br /> ENVIRONMENTAL HEALTH DEPAP.7MEldT Te- <br /> IiG SJNOERGROUND TANK(UST)CLEANUP Sr E(LOP) lt;5 ousimo ADATFMW Te- WASYe FAC1UnrNEHf LE <br /> �` ER CLC-ANUP SITE(NON-LOP) Q FOOD FACaITY PJ. �rxs7E TIRE L J <br /> �6RGROUND TANK(MQN rOR[HGfRFMOVAL) la DOG KENNEL f?'T�aIRr <br /> �G��.,HAZAP kis WASTE GeNERATOR ❑CHICKFN RANCH AIWATER TREATMENT PLaNT <br /> ❑TI6REo PERHITTE❑FACturY a MOTnMOFEL Q PU0.IPERTRUCKJYARVfcHEM ToL'Ts � <br /> 13 TATTOCWBODT PIERCING ElPOOLISPA 1 D U3E APPUCAnON SITES <br /> (PFMLallom <br /> ❑VEDICAL WAST£FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIIJWLE FOR REV;UW - MONDAY-FRIdAY 8:00 AM-5:01DPM • EXCLUMNG HOLMAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 208 464-0938 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:44 pm will be processed the next business clay. <br /> 2 The EHD will notify the applicant if any}"HD files e4st, An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application_ The files will be held for a maximurn of five lousiness <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD 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 same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may required$93.00 deposit prior to review. <br /> Lj <br /> • S�1 t 1 :� l��` ' <br /> x.11' 3. ti <br /> �y v <br /> EHD AEA2-om <br /> v�Area ' <br />