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Oct 20 06 08: 35p 0 0 p. 1 <br /> 10/20/Y2006 12:24 4640138 EA'N'�VIRONMENTAL HEALTH <br /> D SAN JCIAQCTIIV'.4OUNTX - PAGE. 01 <br /> U 1 I !5 FI NVMONMNTAL fhEALTII I)EPA12TMINT M <br /> � �Tb 304 Fast WObt T AMue,3`d Floor,Stockton,CA 95202-2708 U/ <br /> Teteph 011e:(209)468-3420 Fu::(209)464-0138 Web:ww%v.sjgov.o&ehd / <br /> ENVIRONMENT HEALTHl <br /> PERT CI'QiJBeY,�ffC�yREC PWS nLEASE APPLICATION PILICATION _ <br /> APPLICANT-. j.l�✓p�s !.'s-rRAt?,4 saslNssslac,�e+ci•:' t 0 0UT/1/S1�/i O�f1TOh',� <br /> ADDRIES3: 3 covN7Y s sv�r 3a� ,7"s/�Ov -J.z3 vg <br /> PHONE tt). 7 1 X WPI40NE MI; - FACSIMILE: <br /> TENTATW APPOINTMENT DATE: Time: <br /> (Please allow 16 buslro days from date of appeeMV.submittal-"rerras'ro only-must he conliitmam <br /> CHECK ROX TO EXPE UE REQUEST:-tn3.Do EE H OR(SiECK OPdLY)•FE4LIE9T PR�E63F.0 tN 3/BL'Sav SS DAYS <br /> SIGNATURE OF APPLICANT DATE 10 <br /> q0 (tonic irsfortraJora: [';L.ist Map—pesoription: -� <br /> 7F&.liADDRESu F7iD USE ONLYstreet 0 L Unit I�. vp. TRR C °c `ll <br /> 2 <br /> ❑.Unit2 <br /> 34. <br /> . V t3 <br /> ,6. <br /> ' s <br /> 7. - - <br /> L unit 5 <br /> 8. <br /> ! Unita <br /> SpociRc Date Range sof lnforrrtation Requested:From - to _ <br /> EN%gkOfIMENTAL HEALTH DEPARTMENT FILES - <br /> O prme,3camnm TANK(usT)CLEANUP Smi(LOP) C5 NOVSNG AMITMEW a� rn WASTE FAauwma <br /> OtNERCLEARUP SnE(NON{Oft) 0FDW FACILRY CI WASTETIIE <br /> Vr4*XGaoutMTMos(PdOran,RINGcfh�u0YAL) ❑DOG K24NEL C7 DnmY <br /> IWu Mli3WASaa clanP.A71,11 0CMKKEN RANM 0 WA MWATCPTMATIJENr PLANT <br /> LT TLErMo Pnndrtf3a FAcB.irY M Mor"creL CT PUMPERTMJQUYAkG)CWMT0ILET3 <br /> D TArTcx MMY PIEQCM C7PWAUSPA <br /> LT MROMAL WASTE FAMUrY 6Y�rnFs!IPLtSA3T SPCpFYI r3/1L ff7 �S.�t'"(1JY�'✓` <br /> WMLAW SE+77C PEF.WP IMCOP 3 AM.AVAILABLE FOR RAYM. MONDAY•FLe0AY8:G0AM-5=P1fi • EXGLUDINGHOLIDAY3. <br /> 1, Us[up to ton addroes os In the space above. Select the type(s)of hies from the list above by checking the appropriate <br /> box os). At least one HIS type MUST be selected. Fax to(209)464.0138 or mail to F�y.I A address Indloatod above. Address <br /> ranges ml!not be accepted-for additional assistance with file addresses,r,.ontact the EHD.Applications received after ' <br /> 3:00 pm milt be processed the next business dav, <br /> 2. The EHD will notify the applicant if any END fi1Gs exist, An appointment for relflety will In corflMn"approximately teff(10) <br /> days after receipt of application. The tilos 10111 by held for a maximum of five business days for review. Appointments <br /> should be sched0ed accordingly. <br /> 8. A file that is actively being worked on by EM staff may not LIB immBdiatoly avellable for review. A new appncatlon may be <br /> submitted when the fiko Is available. <br /> 4, Any file not returned In the same condition as released win he reorganized by.FHD staff at iiTr expense of the applicant. <br /> Fr,Ltum file raviem.by the azms applicant may require a SBSMdeposit prior to reviavr.. <br /> 101 1� ?lir Me,�i ss S C -- . <br /> 1 <br /> Si - -.-�--.�-- <br /> �'w aursc4 <br /> vi. Incur 6%40 'Rn" <br />