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ieivv, vvo IL.vo rnA _ @ 002/002 <br /> 11/19 � ��101:. ENVIRONMENTAL F -H rY of <br /> SAN rOAQ�COUNTY <br /> EHD BOG NUMBER <br /> f� 0 4 2006 ENVMONm]ENxdAL WEALTH DLrARTmENT <br /> 7�5 304 East Weber Avenue, 3`d Floor, Stockton, CA 4-0 95202-2708 <br /> �D{ }ONNIENT Hht4hoaet(209)468-3420 Fax: (209)46138 Web:www.3 gcv.orV011 <br /> G• PPERMIT/SERVICES <br /> PMAC RECORDS RELEASE APPLICA•7.'XON <br /> �1 <br /> APPLICANT:_��7I !n 5TH r (7UBMESSlAr,:ENCY: 1r� �c IO'� <br /> APDRESSId <br /> PHONE(1): PHONE(1): FACSIMILE: 9`I 9-06 c't I Y <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please snow 10 business days from date of apprication submittal••I)WRam only-must be confirmed) <br /> b CHECK BOX To EXPEDITE REQUEST-M00 FEE(CASH OR CHECK ONLY)-REClUEST PROCESSED M 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic InforltlatiOn: ❑ List❑ Map—Description: <br /> PILE ADDRESS EHD USE ONLY <br /> Strout A Street Name City ❑ Unit 1 <br /> ;Mo m I'S o4 d 6-6 l= <br /> 2 Unit z <br /> 3. <br /> 4. �Unk3 / <br /> 5. <br /> 8- vUnit4 <br /> 7. <br /> ❑ orae s <br /> 8. <br /> 9. unit a <br /> 10. <br /> Specific Data Range of Information Requeswdt Prom to <br /> ENVIIk0NMF..NTAL HEALTH DEPARTMENT PILES <br /> UNDERGROUNo TAM(UST)CLEANUP SIM(LOQ O Holrsato AEAnOWT K 3000 WASTe FACARYIVEIKLE <br /> III Olt M M1AMP Sire(NbN-Lop) O FOOD FAcurr ❑WASTE Tont -"'�• <br /> R UWXRCItDONO TANK(MONIMPINGIREMOVAU 0 Doe Klg T PL DNRY . <br /> P,HAZARMS WASTE GE:WRATOR C1 C1110"RANG{ WAsTEwATER TREATMENT PL AW' <br /> ❑TIRRED P041hrren FAC LrrY El MOTELIHmn PUMPER TRUCKrfA m1CHESI To"n <br /> tl TATTO6ii800YPWA0fNG CI POQLrPA I LAND USaAPPUCATION a,1Es ' <br /> P MEOIGe.wa FAGLITY O OrtwR(PMAsd SPECIFY) <br /> YMA•AND Sena Pm=T Pacui DS ARE AYAnAet.e FOR REVIEW- MONDAY-r=AT a:OD AM-5:Owu - EXCLYOM HOLIDAYS. <br /> 1. Uet up to ten addraaaea In the space above. Select The type(s)of tiles from the list above by Checking the appropriate <br /> box(es). At least one file type MUST be selected, Faau to(20914640138 or mail to tho address Indicated above. Address <br /> ranges will not be accepted for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next buslness day. <br /> 2. The EHD will notify the applicant If any END files exist. An appoIntment for review will be confirmed approximately ton(10) <br /> days after receipt Of application, The filoa will be held for a maximum of five butinass 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 review. A new application may be <br /> submitted'whan the file Is Rvallable, <br /> 4, Anyfiie not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future fife reviews by the same applicant may require a$95.00 deposit prior to review.. <br /> EHD USE ONLY <br /> MP Nuc sn ova <br />