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04/25/2008 09:40 FAX Z001/001 <br /> 134/25/200B 09: 43 209d640t"J!K ENVIRONMENTAL HE"AeFH PAGE 0 r'v -, <br /> -� EHD LOG NUMSPER <br /> DATE RECEIVED SAN JO,A1QUIN COUNW <br /> ENVTRONMEN AL HEALTH DEPARTMENT <br /> 600 East Maid.St. Stockton,CA 95202-2708 <br /> Telephone., (209)468-3420 Fax: (209)464-0136 Web:www.aj v.org/ehd <br /> PUBLIC RECClRAS BELT 149E APPLICATION <br /> _ReecA Y1ercow <br /> APPLFCAN7:'i i'1.1��� I HUSIPtFSStAGENGY: _ _— <br /> ADDRESS: 4 v r n'� e, 0,k q-, 21 <br /> PHONE(1)' al 400. 0208 -_PHONE(2): 44L+�-, FACSIMILE: qlLe , 0.0(D4:)5 <br /> TENTATIVE*APPOINTMENT DATE: -- Time- <br /> (Please allow 10 busln*s s days from date of application submittal-*Tentative only-mumt be 0000+edl <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED INS BUSINESS DAYS <br /> -''y SIGNATURE OF APPLICANT 'T A0 _DATE 4�, ?--1 108 <br /> Electronic informatlon: ❑ List 0 Map-Desc'ription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street P r- street Name City Unit 1 <br /> 1• 4_Z415 !`IZ�MCtJT ST R �JTbGV-Tc. <br /> 2. q4'j 5 h t et�lbtJT `fir & ToGic-Ia r3 � Unk 2 <br /> 3. t} t�1QNT 6'r E „ C� <br /> 4. <br /> . unit 5 <br /> L-11 �lyyl <br /> Specific Dat* Range of Information Raqu*sted:From to _. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGROUND TANK(UST)CLEANUP SM(WP) 0 H+�ousiNe ADAfaMANT )R aOLO WASTE FACILrTY1VM10U <br /> orniaR CLQANUP SITE(NON-LOP) C3 rwo FACILnY C1 WASTE TIRr. <br /> utmaauRouND TANK(WONrToRINGIREMbVAL) 0 DOG KENN$). 13 DAIRY <br /> HAZARDOUS WAA?t GENERATOR C3 GKICKEN RANCH In WASTEWATER J`RI!ATMENT PLANT <br /> 0 MEREb PERMrTTEII FACILITY 1;3 MmUHOTEL ❑pumpekTllUCK/YARniCM!!M TeILeTe <br /> 0 1rATT0011%ODYPI9RCINO 0 POCUSPA D LAND USE AppUwioN SrTES <br /> C7 MEDICAL WAAT9 FACILITY 0 OTHt1R(PLEASE SPF.CirY) <br /> WELL AND SEPTIC PERwT RECORDS ARP_AvAit-AaLE FOR R/vlow -MONDAY_FRIDAY 8.00 AM-5:0DPM - EXCLUDING HOLIDAYS, <br /> 9. List up to ton addresses In the 90906 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 selevtad. Fax (209146 13A or mail tQthe 2ddre5slndicalgd plbove. Address <br /> ranges will not be accapt*d-for additional assistance with fila eddresses,contttot the FI-10. Applications racalvsd after <br /> 8:00 pm will be processed the next btaslnaaa day. <br /> 2. The EIID will notify the applicant If any SND files exist. An appointment for r®view will be confirmed approximately ten(1 a} <br /> days after recelpt of appilatltion. Thu files will be hold for a maximum of five buslnoas days for revlaw. Appointments <br /> rhould be scheduled aaoordingly- <br /> 3. A file thiitt Is actively beln4 worked on by EHD staff may not be Imm*diateiy avallabl%for review. A new application may be <br /> submitted whop the fila la evallable. <br /> d. Any file not returnod In the same condition as r'tletased will be reorganized by RHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If u need further ttssistdnee PleAS9 =TtaCt bla" Martlnax 0 (209)468-294Vdirltctl , Thank YDu"'"'" <br />