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NRR.10.2005 10:59AN APj6ENVIROTECH.INC. <br /> N0.289 P.1 <br /> DATE RECEIVEDD/j EMD LOG NUMBER <br /> UE� V �D NV1ItONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton, CA 95202-2708 <br /> MAR 1 0 2005 Telephone:(209)468-3420 Fax:(209)464-0138 Web! www.sjgov.org/ehd <br /> Ek ROWNT HEALTH PUBLIC RECORDS RELEASE "PLICATION <br /> rn e€11rGIEfjI h�tv�1! <br /> BUSINESSlAGENCY; A{3•tk• <br /> ADDREss:_ 2io V.7 4w�t �rry L Tu.rloUct t/1- cr711 r,!_ <br /> PHONE(t): t (.ter^ (e'Vd L PHONE(2): V+ T t.r 'C -OIQ 4-1- FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: IAVCA z�. Z�1r Time! �4 <br /> (Please allow 10 businass days from data of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST.S93.00 PEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT JLC DATE 31110/0'r <br /> UNiTDisTRIBunoN ❑Unit1 ❑ Unit2 QUnR3 Unita Unit$ ❑ Units E] Other(alactrenic/listelinaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Strom* Street Name City <br /> U4-y1 tKt I\T <br /> 3• +, ec1fS o� SfLtL 7:- L )4. IV�6C1� NIS Awa 4 N - fT57. LY�I " r.G.: <br /> 9. '-/3y _ t3 _ La tWt- S <br /> 10. fo'{ZI p;ha n-wt l oc( cw <br /> Specific Date Range of Information Requastad:From to Irfk--� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGROUNOTANK(US-0 CLEANUP SITE(LOP) O HOUSINGA9ATEMENT r3 SOIID WASTE FACILMNEHICLE <br /> 0 OTNER CLEANUP SITE(NON-LOP) O FOOD FACILITY 13 WASTE TRE <br /> ❑UNDERGROUNO TANK(MONITORINGIREMOVAL) C Doc KENNEL ❑DAIRY <br /> E3 HA7A11DOUS WASTE GENERATOR to CHICKEN RANCH A WASTEWATER TREATMENT PLANT <br /> ❑neREo PeRMn7m FACILITY ❑MOTeLlHoTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATIOm[BoDY PIERCING 13 POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY M CTHER(PLEASE SPECIFII <br /> WELL AND SEPnC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 13;00 AMS:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to tan addresses in the space above, Select the type(s) of fifes from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to J209)4644138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review wilt be confirmed <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked 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 same 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 /> „ <br /> PHD ae.oxaoa <br /> 7nu05 <br />