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A /0G.'200G 16: 24 4641113 EI _ ENVIR❑M-4ENT�L HEALTH <br /> EE—LINVE19IDD <br /> F'i=�iaE F12 <br /> SAN JO Q UIN COUNTY L-, <br /> —' 40i 2007 NVIR0NMFi` TA.L HEALTH DEPARTMENT <br /> , Stockton, CA 95202-270 <br /> taAfftj - jTrlepho e:'(209) 46 3420 Fax: (209) 464-0138 Web: '"vw-sjgov or2d3 <br /> PERMIT/SERVICES 6_60 <br /> PU LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: tr BUSINESSIAGENCY:_ C._OV1ES��YG -- �1,��,� f��soet'40 <br /> ADDRESS: O 1 i v' ,- wa �k�` YU0 11 <br /> S [ 9'S Z U d�iivv <br /> PHONE (1): 2n 3- Ce l Q PHONE (2): FACS;MILE: ( 20`l <br /> TENTATIVE*APPOI TMENT DATE: �/ O � �b E'hn 16� Time: v< <br /> W <br /> (Please alfow 10 bu iness days from date o applicatio subrnitta�ntative only-must be c nfirECK BOX TO EXPEDITE EQUEST 93 00 F ( 0 HEC <br /> Y) -REQUEST PRO^CSSED IN 3 8 <br /> SIGNATURE OF APPLICANT ATE _ 5! 41 /'p <br /> UNIT DISTRIBUTION ❑ Unitl' ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 0 Unit 5 ❑ her(electronic/listslmaps) <br /> FI E ADDRESS HD USE LY <br /> Street# treet Name City <br /> E I I�' �� _ e I— Tsu.W _ i�St 6� 0 <br /> Ii'" sire ova no _ I - <br /> 3. 55. ._ I <br /> -t V, ` US I v v 1 <br /> G 4. _�( i-n. A _. el zJ <br /> 5. Z K 5 — _(1 T'^ g�- '[y'�ILIA— h U <br /> h Q I F C. <br /> 2 K E o S+ __ <br /> ' 9• 7-04f I E J lam^ _. w <br /> a ALS a <br /> Speylfic Date Range of Information Requested; From 4L TrAto <br /> ,(\/ ENVIRONMENTA7Af ARTMENT FILES <br /> K� UNDERGROUND TANK(UST)CLEANUPS[ (LOP) ❑ HT 13 SOLID V:, E FA LITY/VEHiCLE , <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 171 WASTE T,iRE <br /> UNDERGROUND TANK(MONITORING/REM VAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL O PUMPER i RUCK/YARD/CHEM TOILETS <br /> C7TATTOO/BODY PIERCING 17POOL/SPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT REG RDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5'00PNI - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in th space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least ne file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br /> indicated above. Address ra ges will not be accepted -for additional assistance with file addresses, contact <br /> the EHD. Applications receiv d after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applic nt if any EHD files exist. An appointment for reviety will be confirmed <br /> approximately ten (10) days a ter receipt of application. The files will be held for a maximum of five business LU <br /> days for review. Appointmen s should be scheduled accordingly. <br /> 3. A file that is actively being wo ked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. :any file not returned in the sa a condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> EHD CB-D6 <br /> 1114/05 <br />