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VJ/LJ/<VVI Il to rMA <br />11 CDU V L� � V C.� klv � irtLnvl• TY I n 14002/002 LOGNUM <br />IL' jl�� / .SAN ,TOAQUIPT COi1NTY `f EHD LOG NUMBbR <br />CNV RONMENTAL HEALTH DEPARTMENT <br />ENVIRMAY 2 5 AWaSt Weber Avenue; 3rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468.3420 Fax- (209) 464-0138 Web- vnvw,sjgov.org <br />ONMENT HEALTH9 q 0 <br />PERMIT/SERPtWLIC 9 <br />Its <br />CORDS RELIvASE APPLI <br />CATTON <br />APPLICANT: i,r r <br />�•��••— �- pl�g^:ESS/Au�diy: r�.rrrir J~� oir <br />ALDftE55: <br />PHONE (1): T 7.1 PHONE (z); <br />TENTATIVE" APPOINTMENT DATE. &CAP FAOSIMILE: <br />(Please allow 10 buslnesa da from 71me: <br />ys date of application submlMal•'7'anfadva oniy-must,; conn�`rnw <br />p CHECK BOX TO EXPEDITE REQU, $95.00 FEE (CASH OR CHECK ONLY) RE <br />SIGNATURE OF APPLICANT' � QUI�Y PROCESSED W 3liUWE$$ <br />DATE _ 3 / <br />Electronic <br />List 54 Mab — <br />PC. iryI RW u5T pLp) Vnit1 <br />El unit z <br />unit a <br />u„u e <br />$, <br />❑ Unit s <br />9. <br />IJ unit a <br />10, <br />L <br />Specific Date Range of Information Requested. From �i b k- <br />to <br />1 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />0(UNIt9R4kOuNb TANK (US't) CLEANUP Site (LOP) In Houma AnATEMENr C7 SOLJD WASTe FAc¢.ITYNCHICLIl <br />ER CLEANUP SITE (NON -LOP) p FOD F <br />NOIRGROUND TANK (MONITURIRMIREWVAL) ❑ DOG KavwL C3DAwT TIRE <br />0flaZARDOUa rTED F CLUT TOR M CHICK"Rµ$1 ❑ WASTENATERTREATMENTPLANT' <br />t7 TAT`TO PFS Fla-rTT ❑� 0 PUMPER TRUCNJyARDICHEM TOILETS <br />f� 7ATTOOIBODY PIERnNG <br />pMOTELMOTEL <br />02, U� (A f ,. LAND USE APPLICATION SrtES <br />❑ MEDICAL WASTE FACIUTY OTHER PLEASE SPEDIPr X02 <br />WELL AND SEPT' PeRerr RECORDS ARE AVARABLE FOR PJ -VM - MONDAY -FRIDAY 6:00 AM-5:00pM - EXcLUDMO HOLIDAYS. <br />1. List up to ten addresses in the space above, Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fix to (2Q91 464,913 Or mDil t0 the ddress Indicated above.Address <br />ranges will not be accepted— for additional assistance with file addressas, contact the EHD. Applications received after <br />3:00 pm will be Procecsed the next business day. <br />2. The EHD will notlfytha applicant If any EHD files exist. An appointment for review will be confirmed approximately ton (10) <br />days after receipt of application. The files will be held for a maximum of five business days for review, Appointments <br />should be scheduled accordingly. <br />3. A file that Is actively being worked on by EHD staff may not be immediately available for re..low. A naw application may be <br />00 <br />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 ekpense of the applicant <br />Future file reviews by the same applicant may require a $95.00 deposit prior to review., <br />EHI] HSI: nNI Y <br />� 1 " <br />