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/ \ 01/20/2005 15:01 916-371-1809 RANEY GEOTECHNTCAL fPAGE J.1/0 <br /> EHD LOG NUMBER <br /> DATE RECCNED _.SAN ct C <br /> JOA.QV CQ-1M JAR ssf' q .©. Vq <br /> __.---d . D <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 ENVIRONMEN'�S H <br /> Telephone:(209)468-3420 Fu: (209)464-0138 Web:www.sjgov.org/chd KR�IT <br /> ^ �^:',I S RELE 45I " PFT IC,NTION j <br /> APPLICANT: 6USINESS/AGENCY: w.E GQ a i C GIRL 'L,a. <br /> ADDRESS: o zar <ivd W¢SE 5jcc SCA S 91 y <br /> PHONE(1): .,. FACSIMILE: r 6/77 T I Pa D q <br /> -� G IiGiJc RI-��� _ <br /> TENTATIVE'APP01"ENT DATEFC(OV'UlJ-4'�rf 2� '�'OC7ei- Time: e' '' (�Z'�t� pjOOe(ca ru.E.t <br /> (Please allow 110 business days fnun dale of appllcatl Sahni— I—ft el 'Tenfativc an(y•most be Confirmed) 1 J <br /> El CHECK BOX TO EXPEDITE REQURSTp- ASH OR CHECK ONLY)•REQUM PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE j4Z0 2va5 <br /> UNIT DISTRIBUriON M unit1 O ul A**3 KOK4 0 UnAs 0 unit O other(elecbonlclllatalmapa) <br /> F14E ADDRESS- H .USE ONLY <br /> _ Shaat III _ Street Name cw_ <br /> UST H I. a .. — vac a2 <br /> usT +1u) �. ADZ LrL ¢�1�A•- j ryt. <br /> ..._ . <br /> U5T HW 3— <br /> 4. t Gr. C .LAea. � U .. ....... <br /> S-it <br /> 1 _ <br /> 6. <br /> 7. <br /> a. .. <br /> _9. <br /> 10. <br /> Spedfic Date Range of Information Requested:From NIS to ✓p & <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> TANK(UST)CLEANUP SRE(LOP) M HOUSM6 ABATEMENT O SOLID WASTE FACILITYNENICLE <br /> rNnIH10"U111) <br /> ERCLEANUP a"(NONJ_OPI13110611 FACIL IWnWAsrE TRiE <br /> ND£RORUND TANKO NROWNGIRem,111L) ❑DOOKENNEL U DAIRY <br /> RDOUSWABNERATOR0 CHICKEN RANCN O WASTEWATER TREATMENT PLANTIER ED PERMITTED FACILITY 13MOTELMOTEL MPUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATToolnoDY Piemme ElPOOIJSPA 11 LAND USE APPLICATIONSn'ES <br /> Q MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> WELL AND SEPnO PERNIr RECORDS ARE AVAKABLE POR REYxW - MONDAY-FWOAY S:OD AM-6:001401 - EXCLUDING HOLIDAYS. <br /> 1. List up to tan addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(as). At least ons.file type MUST be selected. Fax to(2091464-0136 or mail to the addr_e_s$ <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHO.Applications received after 3100 pm will be processed the next business day. <br /> 2. The EHD will notify the a,plicant ifRny FHD fllaa axlst.. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be hold for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file 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$93.00 deposit prior to review. <br /> ENn/ecxaae <br /> 111"" <br />