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uec s'61 ,2UIUU 1 U:23AMJ ACOUNTYii. N0 0989 P l <br /> DATE RECEIVE D l �{ EHO LOG NUMSCR <br /> ISA.N a QUIN <br /> i — ENVXR&N ENT 4)�BIALTH DEFARTMINT <br /> 304 East Weber Amue,3 Floor, Stockton, CA 95202-2708 <br /> ; <br /> Tela one:(209)458-3420 Fax: (209)464-0138 Web: www:sjgov.org/ehd I l <br /> I SPUBLIC RECORDS RELEA,SF APPLICATION <br /> APPLICAMI':—TUELtAW_k2�! BUSINESSIAGENCY <br /> ADDRESS, 7b r S, I—At J�_ __ FLOO12 CITY �� <br /> PHONE1 Q 7 9055-PHONE(z): { <br /> ( �.� 2 3 6 - .I AGSlI16EL.E: <br /> TENTATIVE-APPQIHI`mEidT DATE: I b.Q <br /> ((Please&00W tQ bminess days from dataobf app0 an subMWW-'Terme dnly! be Confirmed) <br /> ❑ cmvo<BOX TG ExpEDITE REQt] FEE(CASH OR CHECK ONLY!-REQUEST PROM=1N 313SINEW <br /> YS 1 <br /> SIGNATURE OF APPLICANT DATE Qb p 0 <br /> iM <br /> tion 13 List D Map- 'ptlanhftrmoL <br /> I <br /> styeIFILE�N� '' EFio USE ONLY <br /> 13 Unit 9 <br /> �. WAU fv u a <br /> nit 2 <br /> 4'5. 0.'I Unit 3 <br /> s. I a Unit 5 .. . <br /> Unlit s <br /> Specific Dat.*Range of Information Requested?Fto <br /> ENVIRONMENTAL HEALTH DEPARTMENT.*ILES l <br /> IxriauNo CAnlrc(UM sxEnrlup Sm'(LOP) <br /> HOUSM ABATEMENT 14 <br /> ;1W.I0WASTE FAC Ln Y1YEit.E <br /> �THEit Ci�AIIUP St1l"(NaN-1.OR) C9 F=FACtLCIY 1ArA&TE 7ir:E <br /> UMMkOROUND7ANK(1gaulTokItIWf AMOVAL) D Ogg KERNM ❑DAF& <br /> WASTE GF eAlott Q CNIQWN RANCH ',Q YYAS WATFA TOATNEWr PLAN <br /> 1iERen PRUM'aD FACL IY G MoTELII"IOTr=L O Puh%PutTRUmvTARD/l mmzALTOu.BTs <br /> G TAr=MODYPWJX0An U P00USFIA C1 LAFiolUsEAPPLICATIONSMS <br /> o Ia913ICAL WASTE FACRM U OMM(PLEASE SPEC" 1) II <br /> 1WM AND UM PERair Fj=ROS An AVAIL As F FOR Igv1Ew-1Y ONMAY-FRCAY 8:00 AY-S.Da PR - EX==AM$HMIP YS. <br /> t. List lap to ten addresses In-the space above- Select the type(s)of files from fhgl�list above by checking the ` <br /> appropriate boges). At least one file type MUST be selacted, Fax to(209)46"138 or mall to the address <br /> indiggedabove. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Appllcations recelved after 3:00 pm will be processed the next bus(n S day. <br /> 2. The EHO will notify the applicant It any EHD files exist. An appointment for reviaw will be confirmed <br /> approximately ten(10)days after recalpt of application. The tiles will itis held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. 3 i <br /> 3. A file that is actively being worked on by EHD staff may not be immedlately available for inview. A new <br /> application may he submitted when the fie Is available. �} <br /> 4. Any file not returned in the same condition as released will be roorganued by EHEj staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 depa'sit prior to review. <br /> IL <br /> !i <br /> Ellp Is-o6 i <br /> iAnlBana �� <br /> � �II <br />