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MAY-29-2009 15:15 Tetra Tech, Inc. 415 974 5914 P.02 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> j 600 East Main Street, Stockton,CA 95202-3029 <br /> Teleph ne: (20q3 <br /> 9) 468- 0 Fax: (209)464-0138 Web:www.sjgov.or <br /> UBLI CORD RELEASE APPLICATION <br /> APPLICANT. 'yi1111 ?.v (1 r'� LJ SUSINES&AGENCY: �L - <br /> ADDREss: 150 5r /Ste. 5o cnyr uhozip c7L).Y1 <br /> PHONE(t): 'J r56' � PHONE(2): 4I1b CAI LZZ( �Rnalrl)- .FACSIMILE: 415 4 59 <br /> TENTATIVE`AP paNTblENT DATE- (�' I al C Pl Timo J Q 0.Yl'i <br /> (Please allow 0 business days from data of appilcatlon subnmtnal-'7'entative only-must be confirmed) <br /> Q CHECK BOX TO F-XP -ITT=REQUEST.$ OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLIGA T DATE <br /> Electronic Information: List❑Map-Description: <br /> FILE ADDRESS_ — -T-- _-.-EHD USE _..---- <br /> 1- Name...- U 't t <br /> Streets I Street <br /> 2. rfz <br /> Unit 3 <br /> 4. <br /> Unit 4 <br /> 6 <br /> 7. <br /> ) I ❑ Unit,5 <br /> 9, -- 101—fl, <br /> J unit <br /> I <br /> Specific Date Range of Inform Iation Requested:From I 00 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ('I n5�/• <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT 9 SOLID WASTE FACIOTY/NEHICLE <br /> L'S OTHER CL£ANQP SITE(NON-LOP) 0 FOOD FACILITY M WASTE TIR£ I J <br /> X UNDFERGROLIND TANK(MONIYORIN'CTIREMOVALP( ❑DOG KENNEL. 0 DAIRY v- 1 (p/q/01 <br /> ,8t HAzA S WASTF GENERATOR�If 0 CHICKEN RANCH A WASTEWATER TREATMENT PLANT <br /> fly TIERCD PFAMITTED FACIIJ-lx \ ❑MOTELJHO?EL ❑PUMPER TPOWYARD(CHEM TOILETS <br /> CI TATTOO/BODY PIERCING 0 POOL(SPA QQ LAND USE APPUCA-nON SITES <br /> ❑MEDICAL WASTP FACILITY O OTHER(PLEASE 5PECIFY) <br /> WELL ANA SE:P'nC PER IT RECORDS ARE AVAILA91-F FOR REVIEW-MONDAY-FRIDAY 8:00 AM-6:00PM -EXCLUDING HOLIDAYS. <br /> 1. List up to ten 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 file pe MUST be selected. Fax t4(209)464-0138 or mail tp the addness in icated above-_ Address <br /> ranges will not be accepte -for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3,00 pm will be processed a next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of appit tion. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled deco (ngly. <br /> 3. A rile that is actively being rked on by CHIT staff may not be immediately available for review. A new application may be <br /> submitted when the file is vallable. <br /> 4. Any file not returned in the sante condition as released Wlll be reorganized by EHD staff at the expense of the appricant- <br /> Future file reviews by the s me applicant rtay require a$105 deposit prior to review. <br /> F.HD USE ONLY <br /> (N <br /> (0-`6 G'• v' <br /> 1 ODD 23& 060 5 2 -r(4 3. C4)OX <br /> (.0001 4s?,(v�i (,ao0l�tly(o, Ct9tD0(QS�Zt (�ODZD�35Zc7j co04�D u� __ © 60 0,90 54 fl <br /> EC �OSEHD48-06 5/04!06 �PBLORO �EAPPF N <br /> �ZD <br /> CO b0)l0y 7z, M, f000 O�O(o ( N .7co0011-11sl woo <br /> �I I,DODzsyN(of �Z�j 335 <br /> (10Due 1 Sl, TOTAL P.02 <br />