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4� `�► r:HI7 LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY , <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 640 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 rax; (209) 464-0138 Web: www.sjgov,or ehd <br /> PUBLIC RECORDS RELEASE ,APPLICATION <br /> APPLICANT- USINE <br /> Abt7Ft6SS: �a _ �1 QA i 9S <br /> PRONE= /,=,Ll—j2335--•PHONE(2 (0 �^� O FACSIMILE Y&y" <br /> TENTATIVE*APPOINTMENT DATE: Time: 4 44A - <br /> � (Ploaso al(vW ten business days fr m da( of application aubmIttal-'TentaVve only-must be confirmed) <br /> l�cHel]K BOX TO RXPE;01 EST 88.0 F ASH OR G ONLY)-REQUEST PR==SSED IN THRE U (NESS DAYS <br /> SIGNATURE OF APPLICANT DATE= <br /> ElectronIc Information: E] List❑ Map Deserlptlon: <br /> PILE ADDRESS EHD-USE ONLY <br /> - stteatS ��y�.. Street Name -�. .. City ~ ❑Unit 1 <br /> 14497 100 <br /> 2. _ <br /> 4. . . . . . . . <br /> f,. <br /> •4Jnit.il- <br /> 7. <br /> 8. <br /> ❑Unit S <br /> _ 9 <br /> Unit 6 <br /> Specific bate Range o information Requested: from to <br /> // ENVIRONMENTAL HEALTH•DEPARTMENT FILES <br /> W-1 NOERGROUND TANK(UST)CLEANUP SITE(LOP) C HOUSING ABATEMENT 171 SOLID WASTE FADILITYNE•NICLe <br /> C] OTHER CLEANUP SITR(NON-LOF) ❑FOOD FACILt1Y ❑WASTE TIRE <br /> ❑UNDEAGROUNo TANK(MONITORINGARFMOVAL) ❑DOG KENNEL - 0 DAIRY <br /> 0HAZARDOUS WASTE GENERATOR ©CHICKEN RANCH CIWAST13WATFR TREATMENT.PLANT <br /> M TIERED PERMITTED FACILITY ❑M0TEL1HcrrP_L 0 PUMPER TRucKIYARDICHEM TOILETS <br /> 13TATTDOI13ODY Pir-RCING 0.POOL SFA O LAND USe APPLICATION SIV90 <br /> 0 MEDICALWASTE FACILITY d OTHI•R(PLEASE SPECIFY) <br /> WELL AND SWnC PERMIT RECORDS ARE AVAILABLE FOtt REVIEW - Mowmy-FRI DAY 8:00 AM-S-Gopu • EXCLUDING HOLIDAYS. <br /> 1. Llst up to tett addresses In the space above. Select the type(s)of files from the list above by-checking the appropriate <br /> box(es). At(east one file type MUST be selected. Fax to_f O)04_4130 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the E.Hb• Applications received after 3:017 pm will <br /> be processed the next business day. <br /> 2, The EFlb will notify the applicant If-any PHb files exist. An appointment for review will be confirmed approximately.ten <br /> days alter 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 the EHD staff may pot be Immediately available for review, A new application <br /> may be submitted when the file is available. <br /> 4. Any file not returned in the satne conditionas released will'be reorganized by FHD staff at the expense of the applicant. <br /> Future flip revIewa U the-same a licant may require a$98.00 deposit prior to review. <br /> Y PA Y A <br /> 14 EHD USIiE ONLY <br /> k <br /> I <br /> r <br /> FHp 44-El 10+21107 PYALIc ryF00RD elan APr FORM <br />