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a <br /> 01/24/2005 15:34 CLAY,'�_'N GROUP 4 12094540138 NO.839 DO <br /> LfMRONMENTAL H' TH PAGE 01 <br /> Cull LW LYUMOC» <br /> DATE RECEIVED <br /> SAN-JOAQUIN COUNTY <br /> ,i ���� ��_--^ -ENV�RUNMENTALHEALT1( EpARTMENT <br /> 304 East Weber Avenue,3rd FF66-r,�tock`ton,CT"52 -2708 - - — - - <br /> Tele hone:(209)468-3420 Fax: (209)464,013&Web! w�vw.sjgvV.0r910hd O <br /> 2 4 ?005 P <br /> WNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIRON <br /> PI _ - SUSINESS(AGENCY: <br /> ADDRESS: .24 <br /> PHONE(I): y2Y-- — b PHONE(Z); Z GO Z/C1 y FACSIMILE--- <br /> TENTATIVE`APPOINTMENT DATE: Tithe <br /> � (Please allow 10 business days from date of application submlttai-'Tcntafive only.must he conSrmlyd) <br /> AM_si U iI12NCHECK BOX TO EXPEDITE REQUEST-$93,00 FFE(CASH OR CHECK ONLY)—REQUEST PROCESSE171N 3 gUSiNi=SS HAYS <br /> SIGNATURP,OF APPLICANT DATE <br /> '1 UNIT DISTRIBUTION Q UnL%i Unit 2 Unit 3 Unita Unit 5 la unite p other(clesban[cJlistslm9ps) l <br /> FILE ADDRESS F_tip USE ONLY <br /> --sitre0t R Street Name Ci — <br /> 1. 32v s+ Mer <br /> W.ta;f- t <br /> 4. <br /> 7. <br /> to , <br /> 5{iecifiG Data Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑Housm ABATEMENT D!SOLID WASTE FACIUTyrVFieCLE <br /> "rtoERGRouND'CANK(UST)CLEANUP SITE(LOP) El Foop FACILITY C)WAM TIRE <br /> MT14ER CLEANUP SITE(NON-LOP) 0 000 KEKWL ,G.7,�OY�jorty <br /> 01TNDERQIgQUND TAMC(MCINITORIHGIRE1 QVAQ ❑CHICKEN Rmc?I 1� ASTEWATE>4 TREATNENY PLANT <br /> M-HAZARDOU5WASTE GENERATOR Cl MOMVHOTEL [3PLIMPIrRTRUCyjYAQDICKEMTDRl=T3 <br /> aS_MFRr;D PEiRMI TED FACILITY ❑.POpLf$PA 171LAND Use APPLMILTION SITES <br /> C.]TASTOQIBODY PIM-HCINO MOTHER(PLEASE SPS <br /> 0 NjuuCAL WASTE FACILIYY <br /> F, <br /> WELL AND SePTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY PRIPAY 9:813 Ata�:ac ^ - I CCLUDiNG HoLIOAYS. <br /> 1. List up to ten addresses in the space above. Select the typc(S)of fifes from the list above by checking the <br /> 09 464-0121 <br /> appropriate box(es). At least one file type MUST be selected, <br /> or Fax to.Anal ass stance with fileladd 0SCsrcorttacl <br /> indi,,_,sated above•. Address TangeS will not be accept <br /> the EHD.Applicatluns received after 9:Q0 pm will be processed the next business Mont for review will <br /> ed <br /> 2. The EHD will notify the applicant if any EHD files exist. An appoint <br /> be held for a maxlnnurn f five business <br /> approximately ten(10)days after MCeipt of application. The files <br /> days for review. Appointments should be Scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staffmay not be immediately available for review. Anew <br /> application may be submitted when the file io available. } <br /> 4. Any file not rett)Mod in the same condition as released gilt be taorgarsized by EHD staff at the expense of the l <br /> applicant- Future Lite reviews by the game Etpplicant may require a$93.00 deposit prior to review. <br /> Enlo.l-p a-aoa :i <br /> I1.1M4 <br />