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4S,1/21/2007 15:07 FAX 1a002/003 <br /> t16/2006 08:54 464013E ENVIR�NTAL HE�H PAbh III <br /> q jf ' SAN JO.A�QUIN COUNTY EEro Boa f�uMe� <br /> ! -� EnMONMNTAL EDM17H D +'P.ARTmNT <br /> ✓ 304 East Weber Avenue,P Moor,Stockton, CA.95202-2708 <br /> Telephone:(209)468--3420 Fax;(209)464-0138 Web:www4gov.%Vehd <br /> G PL713LYC RFCOP.DS RELEAS)EAPPLIC.A.- MT 1713 <br /> Ai'PL�1; �� �' B � iOF" <br /> ADDRESS:—z u zi <br /> PHONE(1): O P'i cl y�� /3 t"l S PHONE pa: �Acs1Mn.�: Ze 24q <br /> Y <br /> 7fNTATVX*APPoIHTMEKT DATE:- <br /> 04ease allow 10 business days from date ofappliea(lat submltW-`T4:;b41ti only-moist be confirm" <br /> ❑ CHECK BOX To E7CPEDrrE REQUESt-32&00 PEH GHECK ONLY)-REQUEST PROG ESSED IN 3 BUSINESS DAYS <br /> SIGNATURh OF APPLICANT DATE T fZ1-a7 <br /> Electronic Infonnatlon: [I Listp es ption: <br /> FILE ADDRESS EHD USE ONLY <br /> Saint 4 Street Name Cffy 13 unit T <br /> 1. <br /> Z G' G q Urdt 2 <br /> 3. <br /> 4. /I unit 3 <br /> 5. <br /> Unit 4 <br /> 6, <br /> 7. D unit s <br /> 9. <br /> Spoelfte Data Range of Information Requested:From to <br /> i:PlVIrtOMMENTAL HEALTH DEPARTMENT FILE$ <br /> .8I UN mTawc(US»CLUMP Sm:(LOM D HOUMN AesTO&Orr13r�wasa:FAcamrimiciz <br /> 40-OMM CiAmw Sm:(NoN{OP) O FO KED 13 DaTM ~~• <br /> Rain TmW(MMwof 31diMMAt) <br /> WASTE GET1eMIVR 13 099E N PW4CN jkWAWMVV 1TEFtTMTMtW PLANT' <br /> O Trw Paaar'w FAOM 0 IMOULA40TEL O PWWIiR TW)C K/YANVCM TOILM <br /> 13 TA17d01S6DYiWtG 9 13 POOL/SPA CI LAN*USE ApmicATI*N WN <br /> 11 <br /> MEDicAL WAarrol FAwM O CT ER(PLEASE SPECIFY) - <br /> WELLAND&rm PaRMIT RawRDs AREAVAILutz Fon Rev1Ew• MtotMAY.FmAY 9:00 AM-5:00M - EXCLVMQ tk=AYS. <br /> !. List up to ton addresses in the space above. Select the b"(4)of files tlrom the list above by checking the 2pprop6eto <br /> box(es). At least era file type MUST be selected. Fax to(2091464-0128 or mail to tbg gl4roxx indicated above. Address <br /> ranges will not be accepted-•for additional assistance with fila mWasses,contact the EHD.Applications retched after ' <br /> 3:00 pro will be processed the next bm.%Iness bay. <br /> 2. The EHD will notify tho applicant If any EFID files exist. An appolnUmnt for revbewwlli be confirmed approximately ton(10) <br /> days attet•reolpt of application. The mon will be held for a maxinwm of five business days for review. AppolnWnts <br /> should be Scheduled accordingly. <br /> 3. A,file that Is actively being worked on by EHD staff may not be Inoodiatoly available for m-Avw. A imaw application may be <br /> submitted when the filo Is nval(able. <br /> 4. Any file not returned in the same condition as released will be reorganized by F.bip 6taff at the expense of the applicant <br /> Future file reviews by the soma applicant may require a$95.00 deposit prior to review.. <br /> EHD USE ONLY <br /> EHP{ams 911 <br /> 1 <br />