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0 SAN JOAQUIN COUNT'S <br /> . EN V iRONMIVTAL HXALxH DEPARTMENT <br /> 304 East Weber Ave>itue,3td Floor,Stockton,CA.95202-2708 <br /> ep oat::M9)-4-69-34 20 Fax:(209)464-0138 Web:www4jgov.0 <br /> r9 <br /> /e1d <br /> A (). 7 /0% <br /> PUBLIC I . COPDS RIZLEASE AAPPLICATION <br /> APPLICANT: v49,11V � ly 6USIKEWAGENCY1 <br /> ADDRESS: . <br /> PHONE(I Y. T_PHONE Z ZAGa 1, 74FACSIMILE:. <br /> • v <br /> TENTATIVE*APPOIN�DATE: Tune: <br /> (Please taifow i0 business days kom date of s#p ation subattWA•"Tentative only-mtmt be cortfim 4 <br /> CHECK Box To wEDrm PR S93.Q0 FEE(CASH Oft CHECK OPit..Y)—REQUEST PROCESSED'IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNR DISTRIE3 UM►N O MIR 1 O Unit z • ❑Unit 3 Cl Unit-4 -0 Unit 6 I] Unit 6 t3 OOW(elecb-oMcAistsThsaps) <br /> FILE ADDRESS <br /> EHD USE O <br /> 5trcot street Name �y I,l4Y <br /> 4. <br /> 5. d _ g . <br /> 6. <br /> 7. <br /> 8. r,p <br /> S. <br /> 10. <br /> 'Specific Date hinge of Informadon Requested:From to AL^s�A r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I <br /> U0DMQ W0 TAMC(U$1)QXAWW tnu(LOP) o HoWw AeArmw CI SoctD WAste FAca nm OXtE <br /> 13 Ntlr oTmft C xASnt:(Hoe-Lop) ❑F000 FACt M a WASjE TWM <br /> UMMMOUND TANK(Mora OMIGJREw OVAL) O Doo KUaagt. a DAIRY, <br /> HAZARDWSWASMOERt=Fta" a RANGK ❑WASTEWATTatTReATMENTPWVT <br /> dTCLrry <br /> "00(9ooPERMa PCOMPAs� o t,*=.Ut rrtuctdtfA�olCt r�'Toe E rs <br /> tJ4P6D Ust2 Arrt1OJATION WES <br /> O'iRE rAL WAS'M FACILITY <br /> Wt I.L AND SWM PERAW REOW=ARE Av►i1,u pm Rtaim- u0WAYFRIDAY t- AMI�b.0" FxClWR1G HoI IDA <br /> t. l ist up to.ten addresses In the space above. Select the•tyf*s)of files from the list above by checidng the <br /> appropriate box(es). At least one file type MUST be selected- Fax,._to(2091464-0138 or mall to the pddcess <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 tiles exist. An appointment for review will 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 /> dl. 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$63,00 deposit-prior to review. , <br /> i.•^,�\rig' �� <br /> ENE)484244 ' <br /> 71f27104 ' <br />