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vriu n� i��rti��r i r 0 N CJ l <br /> � ' ""nvvu���:1`1UlYTIi' tnuLOGAfl1I�gER <br /> '� :ONMIrr1YTAL HEALTH DFF.Anrogt <br /> �- 304 East``E�cb0r,avenue, 3"Floor,Stockton,CA 95202-2708 <br /> X�J Telephonc:(209)468-3420 Fax: 209 464, <br /> ( ) 0138 Web:ww�y,sjgov.orglehd <br /> PUBLIC REC <br /> Z3uV5' <br /> APPLICANT: CRAS RELEASE APPLICATION <br /> ADDRESS: It 0 LONE P4l.M BvsiNESStAGFNCr: <br /> PHONE(�9_S�q• ZZ�iI v�i `�"t-.��SO 'U A L <br /> �� E STATE C-� <br /> TENTATIVE*APPoIMVE DaT ECS(�: <br /> FACSIMILE: '101.5 °t•ZZZ`j~ <br /> {Please snow 10 busi�ass da '2' 'Q(0 <br /> CHECK BOX TO "date of aPPiic>Atton Subnllttai.•r �m°' <br /> EXPEDITE REQUEST-'9&00 FEE enfafive only-must be confinnedl'� <br /> SIGNATURE OF APPLICANT {COSI{OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> N on o List o A DATE <br /> P-OescriPtion -� <br /> strw I f U ADDRESS <br /> 1, treet Name END USE ONLY <br /> 2. 2 OS city <br /> o S <br /> C U <br /> 3. 2 7. .� <br /> 4. ❑ Unit 1 <br /> 5. Z, <br /> s. ❑ Unit 2 <br /> 2 � <br /> 7• eUnit 3 �1 <br /> s. nit +�\ <br /> 10. <br /> -1011! 111111C] Urn' 5 <br /> SPeeif'c Date Range of'nformation Requested:From ��-� � Unit 6 <br /> to <br /> Fi <br /> (LOP) �ENVIRONMENTAL HEALTH DEPARTMENT FiLES <br /> A�Atl.gg(,� <br /> �DERGROUNO TANK(USIA CtE�wvP SrTa C3 t7 oTMeRf�NUP-SATE_(NON.I.OP) _... .-. Holl IHG AT)MENT.. <br /> UNDERGROUND TANK(M0HITMNGlFt�+gOVAI — FOC <br /> � or:ILrrY -d30LIC WAstE FAc4RY1Va:HICLp <br /> HAzmoou$WASTE GENERATOR i 0 DOC KENNEL t]WASTE TIRE <br /> TIERED PERMirMO FACR►TY Q CHICKEN RANCH t3 DAIRY <br /> C3 TA"oWBOoy PIERCING Q MCITUNOTEL C3 WASTEWATER TREATMENT PLANT <br /> t7 MEDICAL WASTE FACIuTY ©POOLiSSPA 0 PUMPER TRLICKlYAR01CHEMr4LTOQHTS <br /> WELL AHD SE►TIC p T RECORos ARE AV L7 OTNQt(PLEASE SPItcsY) t3 LAND Use APPLK:At1ON SIT" <br /> i. List up to tett addresses in.the space above, FOR s 0-ct the <br /> e.IIION—Y.FRroAY#:00 AM-s:00PM . <br /> E7CCLUDfNG HOLIDAYS. <br /> appropriate box(esj. At least one file type MUST be seletetped`s ofFax tl from thhe 38 or mall rochecking <br /> he ld dress <br /> indicated Above <br /> Address ranges wi11 not be aloaepted for additional assistance with fife addresses,the END.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END files exist. An a c°ntact <br /> approximately ten(10)days after recet of Appointment for review will be Confirmed <br /> aperdays for review. A alAPlicution. The flies Will be held for a maximum of five business <br /> ppointment$should be scheduled accordingly, <br /> 3. al file that is actively being worked on by EHD staff may not be immediately available for review. <br /> application may be submitted when the file is Available. Anew <br /> 4. Any file not returned In the carne condition as released will be reorganized <br /> appiicant. Future file Ill by the game Applicant tnay require as$9300 deposit pro to rEND staff' at eview. Anse of the <br /> EHO 4844 <br /> 1WiUs6o6 <br />