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OCT-19-2005 WED 02:29 PK <br /> FAX NO. <br /> P. 01/01 <br /> DA'rERECEIVI'I) SAN JOAQViN COUNTY <br /> NViRONMF,N'CAL inALTI-i DBPARTNIFNT" <br /> �_ D� <br /> � r A�enuc,Y41100T, Stockton, CA g52t}2-2708 <br /> u 304asf Weber s' =ov.os ohd <br /> • 464-4138 Web.www !6 <br /> � � �QQ�klzitonc,(209)4C�8-3424 t~'ax. {�09) . <br /> OC^� Oq <br /> ASE APPLICATION <br /> ,�1 N <br /> MAC 11FICORDS RELEASE <br /> •p R � } gUSiNE`SSIAGENCYJ:,. � <br /> - � FACSIMILE: . : <br /> ADD#t1=5s:�.�'2--]-•�-`-�� �„.fir I <br /> PHONE(z): I <br /> PHONE=i'i 1: Time: ` <br /> TE�ATIVE_"AF:PIOINTMENT DATE: i <br /> (p)easc <br /> allow')0 business days from date of appAcatiorl submittal'"r R�QU�STtPROC1=S91>aqN 3 gUSINFSS DAYS � <br /> 10 <br /> X <br /> M CHECK I3UTO r:xpF-DITE REQUPSf-593.00 FEP(CASH OR CHFCK Ofd4 DATE <br /> SIGNATURE OF APPLICANT _ •— "`"—�"•4Other(aiectro:ticJiistslmaps) <br /> � Ci Unit 2 Unit 3 nit 4 Unit 5 1� Unit 6 -- <br /> UNtT PI&TRiBUYION .. 1 a Unit 1 — <br /> -. .-. _ EHD,'USEONLY <br /> City <br /> �Strect p _ _..—.—Str7t Name <br /> 4. <br /> A. <br /> 77, <br /> B. <br /> to <br /> Specific Date Range of information Requested:FromLE <br /> ENVIRONMEN7At 1lEALYt1 DEPARTMENTP❑i SPSDWASTE FACIUTYIVEHICLE <br /> CLEANUP$ITE(LOP) 0 HOUSING ABATEMENT n WASTE TIRE <br /> �uNDPRGROUND TANK(UST) t2 F000 FACILITY ❑DAIRY <br /> VfOTIiER CLEANUP SITS(NON-LOP) Q DOG KENNCL ❑WASTEWATER TREAYMENT PLANT <br /> UNDeFMAOUND TANK(MONITORING1REMOVAt) ❑CHICKI=N RANCH ❑PUMPER TRUC14YARDICHCM TOILETS <br /> HAZARDOUS WASTE r'"ERATOR ❑MOTEUHOTEL ❑t ATSD USp APPI.ICATIQN SITES <br /> r7 TIERED PERMITTED FACILITY Cl poOL1SPA <br /> C3 TArtTO01i3ODY PIERCING ❑OTHM(PLEASE SPUCIFY) f <br /> ❑mEOICAt WASTE FACILITY MpNDAY•FR4i)AY$:0b ASI-5:OOP?A , I X¢LUDING HOLIDAYS. <br /> WELL AND$1rFTIG P�RSAIT R>=CORRDDS ARE AAVAILAEILEC Fes.E �^`��"" f fles from~ t OVe by checking the <br /> �.r.-.. ""•" "' <br /> 1. List up to ten addresses in the space above. Select the type(s) <br /> e ted-for additional assistance with file addresses,contact <br /> ra to <br /> box(es). At Least one filc type MILS The selected. Fax—t-00-9 et64-0138 °r 5 tot e address <br /> app p es will not be accepted the next business day! <br /> indicated above. Address rang <br /> the EHD. Applications received after 3:00 pm will be processedontme for review vv ll be confirmed i <br /> 2. The EHIO Will notify the applicant if any EHD hies exist. An app - <br /> ten the; <br /> days after tc:ceipt of application. The files will be hcid for a rs aximUm of five business <br /> approximately { ) <br /> days for review. Appointments should be scheduled accordingly. <br /> trot be immediately available for review. Anew <br /> 3. A file that is actively being Worked on by EHt]Staff may ' .; <br /> application may be submitted when the file i$available. <br /> turned in the same condition as released will be ea$93 00 deposit prior to review. <br /> ens�of the <br /> 4. Any file not returned the <br /> Same applicant may require <br /> applicant, Future file reviews by -- <br /> ghp 4892-iM6 <br /> 1l14lQS ..- I <br /> ,6.y <br />