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MAR.10.2005 10t59AM APrX ENVIROTECH,INC. 1`10.289 F'.1 i <br /> R EMD LOG NUMBER <br /> DATE RECEIVED - SAN JOAQUIN COUNTY } <br /> ENVIRONMENTAL RFfALTH DEPARTMENT� � 304 East Weber Avenue,3"Floor, Stockton,CA 95202-2708 <br /> 2�Q j Telephone:(209)468-3420 Fax:(209)464-0135 Web:www.sj&ov_org(ehd - <br /> MA WWW <br /> VSRON N� HEWH PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAUENCY7 <br /> ADDRESS. <br /> PHONE(1): 7+4t t.�o' _^ �- PHONE(2)" <br /> Tal t�t{tg - b 4-P FAt:S}EA1LE: <br /> TENTATIVE"gppO1NTMENT DATE: <br /> (�I�v Time: <br /> (Ploase allow 10 business days from date of application suhmittal-•T'entativ'e only-must hsa can#Irmed) <br /> ❑ CHECK SOX TO EXPEDITE REQUEST-$93.00-FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 9U81NES DAYS <br /> SIGNATURE OF APPLICANT DATE 3 It4to i <br /> nitk jrantt5 <br /> cl .Unit G d Other(aisctronlerliatrJmaps) <br /> UNIT DISTRIBUTION MUniti MUnttZ MU"113- k <br /> FILE ADDRESS EHD USE OrCY <br /> Streot# Street Name City <br /> F_3 <br /> ( G! V S ?7 <br /> Ul M41� �4CK�nn "� J yr <br /> Q <br /> La rW#- <br /> s. 13yto <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL:HEALTH DEPARTMENT FILES <br /> 18�UNOERGROuNe TANK(UST)Cl-EAH�P SITE(LOP) ©HOWNG ABATENF 'C (l SOPO WASTE FAgt.l'C VEHICLE <br /> E 0 FoOQ FACAUTY d WASTE TIRE <br /> OTHER Cya Nup SITE(NON-LOP) 17 DAIRY <br /> M UNJIMMRDtJNO'rANK(MoNRQRINaIREMaVAL) d DOG KENI <br /> 0 HAzARDms WASTE GENERATOR Q CHICKEN RANCH Q PASTER TNjC fyr Ato/CH PLANT <br /> O TRRCD PERMITTED FACILITY 0 MOTI'LIHOT-L Q PAMPER fl2AJGKIYARIGN!�I I TOILETS <br /> *TA-TboIBOoY PiERcmr, 0 POOLlSPA 0 LAND USBApPWCATION` Es <br /> *MEDICALWASTEFACILFTYM OTHER(PLEMESPECIFY) <br /> WELL AND SOMO PERMIT 17EcoRos ARE AVAIL AaLE FOR RLMEW- M(3NQAY-FRIDAY 9;00 A V_&60pM - EXCLyrnNa HoLJoAYS- <br /> i, List up to ten addresses in the space above. Select the type(s)of files from the Ilst above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464.0438 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional asslstanue with file addresses,contacl <br /> the EHD.Applications received after 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 revie'at will be confirmed <br /> approximately ten (10)days after recelpt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> S. A file that is actively being worked on by EHQ staff may not be immediately available for review. A new <br /> application may be submitted when the fife is available, <br /> 4. Any file not returned in the same conditlon as released will be reorganized by EHD staff at the expense of the <br /> applicant, Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHn 4a-nxaae - <br /> �nuos <br />