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Sep-20-07 04:20pm From-ENVIRON +5106559517 T-430 P.02/02 F-008 <br /> DATE1— ; SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Nelephone: (209)468-3420 Fax- (209)464-0138 Web:www.sjgovh <br /> 3 <br /> ENViRGlVMEN r �iEAET' <br /> PE� Ri T/S�R��irlUBLIC ,fCOS RELEASE APPLICATION <br /> APPLICANT; SI &�-oylYl JVIl���l1JC1 BUSIrN�ESSIAGENCY:�VI P--QM <br /> ( <br /> ADDRESS: 001 Stir Q LIYYIpI�{l!lfil �i�l (�C.� QH ti{V1 .ill VII <br /> PHONE(1).(551 4 _t —?-t�C7 _PHONE�(2). ( FA 'SIMILE: `S <br /> TENTATIVE*APPOINTMENT DATE: nL{ DIO�,I� �LD� - 1 JTlr�t�e � ) <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must ba confirmed) <br /> © CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH, OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Q List(] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name - citY ❑ , <br /> 1• 5307 Fast okay ICP vtST(o�(I; fftN��'',l'► <o' ,ounIt <br /> �et <br /> 2 0.5 0�.1/�-Qk�fil(Q Q. D 't vvk ao d1 (o El Unit 2 <br /> a Z� 4. - Unit 3 <br /> X, <br /> 1I <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. ❑ unit 5 <br /> 8. <br /> 9. Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From (_ a Ulu[ l ak Lf/ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROVND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT SOL.ID WASTE FACH-ITYNEFUCLE <br /> THFR CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUNo TANK(MONITORING/REMOVAL) C I DOG KENNEL C3 DAIRY <br /> AZARDOUS WASTE GENERATOR M CHICKEN RANCH )"ASTEwATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C MOTEL/HOTEL 'M PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOISODY PIERCING 0 POOL/SPA e 1 /�M LA D jJSE APPI-ICAs SITES <br /> 0 MEDICAL WASTE FACILITY POTHER(PLEASE SPECIFY) INR ,I tD,�1 I i7 1'�WI�5 <br /> WELL AND 8EPYIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5-.00FM - EXCLUDI�OLIDAY$, <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(los)464-0138 or mail to the address indicated above__ Address <br /> ranges will not be accepted—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(10) <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 available for review. A new app Ica on may e _--- <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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4a•OB WEB &dries 07 <br />