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VJ/CJI LVV( Il . to r1A, <br /> 11/16/1brl4ppL, '�'//1`1����nnVd^ 4V//pf c 0002/002 <br /> � MCF V � � S t.IVV 1KUlw'L'IYI HU In rLOG tM <br /> r . r �v roa,Qvxrr cotri�rrY EHD LOG NUMB(rR <br /> I ;NVIRONMFNTAL H.FALTH DF ARTMFNT <br /> t'l MAY 2 5 Ea$t Weber Avenue; 3rd k7oor, Stockton, CA 95202-2708" / <br /> Telephonet (209)468-3420 Fax: (209)464-0138 Web.www.s gov.org/ d <br /> ENVIRONMENT HEALTH <br /> 19 <br /> PERMIT/SERPtWLIC Rri CORDS RELEASE APPLICAUON <br /> APPLICANT: <br /> ADDRESS: 28Zs 01191NESS/AGENCY: Ier� tr <br /> M <br /> PHONE(1): q SIB"-1757 "—� PHONE(2,): FAC$IMfLE: x' <br /> TENTATIVE'APPOINTMENTOATE: j4G,4P <br /> (Please allow 10 btuNwVu da from - - Time: <br /> y! date of appricallor,sulxnfHal•'7anfaf/ve <br /> only <br /> be conTnped) <br /> CHECK BOX TO EXPEDITEREQU $95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED W 2 BU ws DAYS <br /> SIGNATURE OF APPLICANT <br /> DATEZ ESb <br /> Electronic Infoltnatlont ❑ List 54 Map-•Descrlpfion: ( �� <br /> FILE ADDRESS <br /> street StreetNama EHD USE ONLY <br /> city Vnit 7 <br /> 1' 2�0 � <br /> z. <br /> El unit <br /> 3, <br /> 4. unH s <br /> 5. <br /> 6, Un1t4 <br /> 7, <br /> g• .171 units <br /> 9. <br /> 10, ❑ unit a <br /> Speotflc Data Range of Information Requastod:prom E 17,4r,khZet to <br /> ENVIRONMENTAL HEALTH DEPARTME=NT FILES <br /> 0l`UNGERCWDUNO TANK(UST)CLEANUP SIR(LOP) P HOU9eia AOAremFNT 0 SDUD WASTE FACaITYIVMCLA <br /> PC=ER CLEANUP Sre(NON-LOP) RCFOOD FACILITY ❑WASTE TIRE <br /> NOERGRCUND TANK(MONrrora A%EmovAL) D DOG VPgrmL ❑ Dmirr . <br /> .CHAZARDOu9 WASTE(3asERATOR OCHICXFN RANCH ❑WASTEWATER TREATMENT PLANT' <br /> 0 TIaRM PEPMrfffb FAca.rTY ❑MOT]WHOTE'L ❑PUMPERTRUCK/YAnWGRffm TOILETA <br /> tO TATroWBODY PIERMND ❑ DOLISPA L.ANC USE APPGCATION SnES <br /> 0 MeoICAL WASTE FACILITY KOTMER(PLEASESPECIFY� At Mad <br /> WELL AND SEPnC PERwrr RECORDS ARE AVAIAOLE FOR REwew- MOWDAY•PPIDAY B:OD AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ton 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 fila type MUST be selected, Fax to(203 464M R 0 mail to tha 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 ton(10) <br /> days after rocolp(of application. The files will be held for a maximum of five business days for roviow. Appointmonts <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately availably for raAnw, A now appiieation may bo <br /> submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will bo raorganixed by EHD staff at the ekpense of the applicant. <br /> Future file reviews by the same applicant may require a 595.00 deposit prior to review., <br /> EHO USE ONLY <br /> eN •ells ,yraos <br />