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Aug 16 07 11 : 37a Marft free Herbert 19251 9738 P. 1 <br /> EHD LOG NUMBER <br /> D d _-�vEE) SAN JO.A,QUIN COUNTY <br /> �`' f 1UENVIRONMENTAL HEALTH DEPARTMENT <br /> j r;1 600 East Main Street,Stockton,CA 95202 <br /> 6 2w Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.tgov.o <br /> NVIRo ? <br /> U1v��'ENT <br /> p p1E41 p, LIBLIC RIECORAS RELEASE APPLICATIONAPPLK AN :NOA DA euSINESSIAGENCY: VV 62 R- - S0t&-h.V-)2%i- <br /> ADDRESS: 11 W. P I Q E �T. �jTl g 5y 4a <br /> PHONE(tk C of ZS q L}1- 2;'-1 3 B PHONE(2): (R2S) 7-1-z--Gi `1 1 FACSIMILE: ZDGI 37,-1--53`14 <br /> TENTATIVE-APPOMITMENT DATE- oo- 3 t —o-T Time: loo-W-1 <br /> (Please allow 10 tsusiness days from datp of application cubmitfat-*TmtaM,@ only-must be conflrtned) <br /> Q CHECK BOX TO ExPEDriE REQUEST-SAS 00 FEE(CASH OR CHECK ONLEQUEST PROCESSED IN 3 SUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 7. 2 C)¢o W. Vva.s h i +0 Sfi. sig Gk+o�n ,v r F <br /> 2. 211 ,� W Wa54.1 �r Sfi. S�dc-- V. fU _ 400 <br /> unit2 <br /> 3. 213 L> W• vUGLs 41: 1 r�n St . _ i-DcLbrl . F _ <br /> �p y1'' Unit 9 <br /> 4. 1 ;7,D50 wmzs�� +b� sr. STOd -+-'='r1 <br /> y7p4 <br /> s. Z 3 oS W. W as hi to•� . 5t. St o c I� c�In unto a <br /> �— - <br /> s. 4-O r\ 6t-_ Sfi=ockv-, V v.i= t�= <br /> r 25Z10 W. Was1-.�� ❑ Units <br /> 8. 2(o50 -VV. 'VVGLS kin 4-o v1 <br /> L <br /> 2-1 oo w. VV CL5�� �n �Jt 5t OG)r--j' l unit_6 W. 1N cLSI-�� art St�_ 5}bcl�Fo,n �1 �' <br /> Specific nate Range of Information Requested:From 0--I1 CLCL4eS to <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> ,fTIUNDMOROUND TAW(UST)CLEANUP SITE(LOP) ❑Houamc ABATEMENT --erSOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NoN4.013) O FOOD FAOuTy ff WASTE TYRE <br /> ,21"UNDE-RGRDU44o TANK(MONITORINWPXMOVAL) ❑DOC KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ,(ErWAsrrWATmTFmATMENT PLANT <br /> TIERED PERM TTED FACK mTy Q MOTEUHOTEI PUMPER TRUCKNARDICHEN TOILETS <br /> ,eTATT001L300Y FERCMG ❑PODUSPA ❑LAND USE APPLICATION$ITES <br /> 'MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT i2ECORD3 ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5.04PM - EXCI-VO NG HOLIDAYS, <br /> I. List up to ten addresses In the space above. S91oct the type(S)of flies from am list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to IM)46"138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EM.Applications received aHer <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 appolntrnent 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 application may be <br /> submitted when the Rb Is available. <br /> 4. Any file not returned in the same condition as released wM be reorganized by EHD staff at the expenso of the applicant. <br /> Future file rewews by the Same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> L-nDso-0e sn6rzaor <br />