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Intl . VAI , I I ul Ii Vv 7 111 I L L Y , . W . <br /> EMD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> DDCD (I V DDD ENVIRONMTNTALIIPALTH DEPARTMENT OO�� <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> 9, A 7no5 Telephone; (309) 468-3420 Fnx : (309) 464.0138 Web: www.sjgov.omh3hd <br /> ✓d <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RLi L L'ASF APPLICATION <br /> PL VI - 6USINVSSlAGENCY: CA �aO <br /> APPLICANT: <br /> APDRESS; <br /> PHONE 11i: 9f(e 87�3 ?2 ,1 PHONE ITR FACSIMILE: <br /> TENTATIVE" APPOINTMENT PATE: Tune: I I a bvt <br /> (Please allow 14 huelnaas days from to Pf appl cation aubmldal - 'Tantaeva only . must be confirmed( <br /> 0 CHECK 60XTO EXPEDITE REQUEST . ;03,00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICA"I^n " " " Af Inas — DATE �i' � N I 05 <br /> UNIT PISTRIDUTION M Untt P Unit2 M Unit 3 D Unit A A init a A Unft fi ❑ Other (oloctranlcnlahslmapa) <br /> FILE ADDRESS _ _. EHD USE ONLY <br /> street u street Noma _ City _ <br /> t . tfri-ofvrtG4t�IGL_ rY -Stn <br /> 2. 5'6U �� A % r dap rA Lj - <br /> 31 <br /> OM <br /> 6. ITr <br /> f _ T 7 <br /> 7. <br /> 10 . <br /> Specific Dote Range of information Requested; From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IINPFROROUND TANK (UST) CLEANUP SITE I -OP) M HOUBIND APATEMENT P SOLID WASTE FACILITYNEHICLE <br /> 13 OTHER CLEANUP SITE (NOWLOPI ❑ FOOD FACILITY ❑ WASTE TIRE <br /> UNDERGROUND TANK (MONITOmNGIREMOVAL) 0 DOD KENNEL P DAIRY <br /> HAZARDOUS WASTE GENERATOR OCHICKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> • TIERED PERMITTED FACILITY MMOTWHOTEL M PUMPERTRUCKIYARDICHEMTOILETS <br /> ❑ TATTOOIROPY PIERCING P PODWSPA M LAND USE APPLICATION SITES <br /> rt MEPICAL WASTE FACILITY P OTHER (PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FRIDAY 0100 A*S:CGPM - FX04UDING HOLIDAYS, <br /> 1 . List up to ten addresses In the space above, select the typ9(s) of files from the list attova by checking the <br /> appropriate box(as). At least one file type MUST be selected. x o zo9 B -0 3e or a o he a ss <br /> Indicated a Ove. Address ranges will not be accepted — for additional assistance with file addresses, contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10) days after racelpt Of application, The files will he held for a maximum of five bualness <br /> days for review. Appointments should be scheduled accordinffiy, <br /> a. A file that is actively being worked an by EHD staff may not be Immediately available for review. A now <br /> application may be submitted when the file Is available. the <br /> 4, applicant. Future file ln the same reviews by the samR applicant mayn as released lll be MID <br /> require a $93,00 epositt priorrtotra reviews of the <br /> EHD 4e-o9-0o0 <br /> 1n�1or <br /> I <br />