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03 / 25/ 2005 15 : 01 20979E 53 APERIO INC <br /> PAGE 02/ 0 <br /> -, (( *r'ws SAN JOAQM C07UNTY <br /> 91 5 ? Q05 ENvIRoNmENTALHEALTj1DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton C 4 95202-2708 <br /> ENV1R01Nfl•' cNT HEALTH Telepboue: (204) 468-3420 Fax: (209) 46"138 Web, wwwsjgov.ory/ehd <br /> PERKT/SERVICES PUBLI1C RFCoRwRELEAN APPLICATION <br /> APPLICANT: T n t�y1E, T� � v�. BUSWB&StAGI:Nt^!. � id � VLG . <br /> ADDMSS: <br /> PHONE (1): "lots 4SSS PHONE (2)! FACSIMILE: 2Da -� 45- � 553 <br /> TF NTATIVE" APpntNTMRN I RAT16: A n r�'• 1 Is 24Q r?— Time: d %OCE ewr 1 <br /> lPR3ase 1VIDw 10 buslni;n days from date �pacdUon a 'S - 'mtaWeonly - mwt b0 cw&Mdd) <br /> 171 CHECK BOX TOEXPWREREQUSST - S9a.00FEE (CASHORCHECK ONLY) � MQUESTPROCMEn1N3BUSMESSDAYS <br /> SIGNATURE OF APPLICANT - . DATE 3 " S- 2.00,X7 <br /> UNrr olsmptmoti ❑ unit 7 nit 9 UnPt A 13 Unk li UAR ti L7 ottw (eteaba9cJ mWMW VED <br /> FILM ADDRESS EHD USE ONLY <br /> 64eetM Street Name City ,1- <br /> 1. a5 t torr l� �� <br /> 2. NINE r <br /> 4. <br /> ) l- <br /> 0. '7 - 3 _ ' /-r <br /> g, pN 00 VA n tc F <br /> Q, Y i �J OGIG rl r <br /> 1D. <br /> Speeifio hate Range of Information Requested: From Q C9 to <br /> e ENVIRONMENTAL tiEALTH DEPARTMENT FILE$ <br /> y <br /> t.. UNOWM0UNP TANK (UST) CLE MP RITI (LO P) 13 HOUSM ASATIMRNT SOLO WASIe F,wnmNEWME <br /> jQOTNER CLEANUP SITE (NON+,OP) o Foco FAMM wasrE TINE <br /> UNDFROROURPTANK tMONT =NNIREMOVAL) d Doe W00% DAIRY <br /> HAZVX064 WA470 GeumATOR 0CHIOWN RANCH t3 WAaTEWATCn TREATMENT PLANT <br /> rT 70`kza 70` PMURT GO FA Iuw 0 MOTELfHOTEL 0 PVMPr.RTRVONIYAAO1CmEm TA1LEM <br /> 0 TATP00190PY PWX01HD 13 PocLISPA ❑ LAM USE APPLICATION SRea <br /> 0 MMACAL WASTE FAMN ❑ PTVKR (PLVJOV SPECIFY) <br /> we Amos m pERMnrtFpoKm Re AVAkALLe FORREyeN7 MowAY-F4u Ye:00AM-S;OOPU - EXWJ0MH0UDAY& <br /> 1 . List up to ten addroases in the spaod above. 5oleet the types) of files from the list above by checking the <br /> appropriate box(es). At laast one fife type MUST be (selected. Fax to (200148"138or mail to the adc(rese <br /> indicated above. Address ranges will not be accepted — for additional assistance with file addrrssee, ContaOt <br /> the 61-10. Applications received after 9:00 pm will be prooeva6d the next business day, <br /> 2. The VHD will natdy the applicant if any EHD tiles exist. An appointment for review will be confirmed E <br /> approximately ten (10) days atter receipt of applioatfolL 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 W actively being worked on by END staff may not be immediatkty available for review, A new <br /> application may be submitted when the fiic iii available. <br /> 4. Any file not rotamad In the same condition ae released will be reorganized by EMD staff at the expense of the <br /> applicard. Future file reviews by the same applicant may require a #93.00 deposit prior to review. <br /> td <br /> NO <br /> $•0P r Lk <br /> EHD A8a2-046 <br /> 1tnnlw <br /> YO roti uI -Ltau n Iu� minaTnua RFTA179b 60 : 5T 5003 /9L/E0 <br />