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-DEC. 13. 2005 1 03P CNOR EARTH TECH �� NO. 4712 '. 2 <br /> l] <br /> ;k,'E.CEIVED l <br /> EHD LOG NUMBER <br /> SAN JOAQUIN.COUNTY <br /> ENVYRONMNTA,U HEALTH DEPARTMENT <br /> i 304 Etlst Weber Avenue, 3'd Floor, Stockton,CA 952022708 <br /> ENVIRO1NN.11.4 i HLAI ' cph°>ae:(209)468-3420 Fax: (249)4640138 Web:www.sjga <br /> F� <br /> P� I►RITIKRUICES <br /> 'UDEIC RECORDS RELEASE ASE <br /> �r <br /> t� i <br /> APPLICANT: " F- EUSINES5/AQFNCY• gP <br /> ADDRESS: Irl o(o <br /> PHONE(1): Z —Off( PHONE(2): 10,01 FACSIMILE: <br /> TENTATIVE~APPOIWMENT DATE: Time: <br /> (Please allow 1 o burin6sa days fmm datc p an Submittal `TsntatiYe only-mast be continTxsd) <br /> ,CHECK BOX TO DI L E UE$T-$93.00 E CK ONLY)- QUFST F ROCESSED IN 3 B SI i <br /> SIGNATURE OF APPLI DATE { <br /> UNIT DISTRIBUTION E2 Undl E1 Wt2 0 Unit ❑UnMAI ❑Unit b d Unit s R Other(alectronidlistslmaps) 1 <br /> - c f <br /> FILE ADDRESS 1HD,USE ON Y 7 J <br /> street 0 Street Name City ] <br /> 9. PAWDAKD1 <br /> 5. , �s+7. <br /> f;. <br /> 10. Am <br /> 1 <br /> Specific Date Range of Information Requested:From <br /> :TiNMIrIp3,',t`A/L HEALTH 1) R7flAENT �r�ES' -- - <br /> IfG�fNDERGROIJNO TANK(LIST)CLEANUP 3rTE(LOP) blri 6rNG AaATE-MENT ��5oua Wi►s7E FAcw'rYnIEH I,.1: <br /> �t]ERCLEAMUP SM(NOH-LOP) C1 FQOO FACRMT H T€T►RE <br /> rAS' <br /> =RGROUNO TANK(MOrMRiNG1R4MO'YAL) M VoG KENNEL RY <br /> Er HAZARDOUS WASTE GENERATOR i 0 CHICKEN RANCH i✓WATER TREATMENT PLANT <br /> 0 TIaFkao PERIIIITTC•D FACILITY El MOTELIHOTEL l7 u P6RTRUcK1YAnv1CHEM To1Lm <br /> El TATTOOISODY PIERCING E3 POOLISPA WLAND USE AppucmioN Sues I` <br /> t..�'MED10AL WAST&FACfuTY G OTHER(PL EAS ESPEcI>=1f) [ <br /> WELL AND SEPTIC PERnnT RECORD$ARE AvAR AeLB FOR REVIEW- MONDAY-FF"oAY axo Am-a.00FHI - EXcLUDING HouDAY& IRIRIR <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0938 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. .I <br /> 2 The EHD will notify the applicant if any VHD files eXist, An appointment for review will be confirmed 4 <br /> approximately ten(10)days after receipt of.application. The files will be held for a maximum of five business I <br /> days for review. Appointments should be scheduled accordingly. <br /> S. A file that is actively being worked on by EKD staff may not be immediately available for review. A new <br /> application may be submitted when the fie is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require'a$95.00 deposit prior to review. <br /> EHD 4x-02-006 .R <br /> VVAS - R <br /> 1 <br />