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06(//155//21007 09:13 4157774874 AGS INC PAGE 01/01 <br /> DATE R�C���,,-JJJ�L-_,i'D'\il. a lJ <br /> SAN�TOAQUIN COUNTY EHD LOG NUMBER <br /> `!.jt'f 5 2007 ENVIRONMENTAI,,HEALTH DrPARTNILNT <br /> EINVIRUNME JT IIEALI-11 600 E. Main Street, Stockton., CA 95202-3029 /16007 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wwwsjgov.oVIS <br /> PUBLIC RECORDS RELEASE .APPLICATION <br /> APPLICANT: C BUSINESSIAGENCY: A CS_ :Lc, <br /> ADDRESS: CAp <br /> PHONE(7): s PHONE(2): FACSIMILE:A <br /> _ <br /> TENTATIVE"APPOINTM N DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-mu d) <br /> CHECK BOX TO EXPEDITE REQU -$95.00 FEE(CASH OR CHECK ONLY)-REQUEST (NESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List Map—Description: <br /> FILE ADDRESS w-._ EHD USE ONLY �� <br /> Street# Street Name City F1 Unit 1 <br /> cc —_ I <br /> 1 d Unit 2 <br /> 3. <br /> ' <br /> 4' 2 �of" �YY� IJ I• Unit <br /> 5 —_ II <br /> — ---•- i°W�T1CzdciS Unit4 <br /> s. 35_50 e U <br /> T 7. Zh <br /> .._, � + ❑ Unit 5 <br /> 9. ...�.2- <br /> r6 u UJ I �' n �• C] Unit s <br /> i0. <br /> Specific Date Range of Information Requested:From l 5_0 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT C1 SOLID WASTE FACILITY/VEHICLE <br /> IK OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY d WASTE TIRE <br /> 19 UNDERGROUND TANK(MONITORING/REMOVAL) O DOG K19NNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> �R TIERED PERMITTED FACILITY ❑MOTELIHOTEL Cl PUMPER TRUCKIYARD/CHEM TOILETS <br /> 101 TATTOWBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> yy MCD(CAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REvIF-W- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1, list up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the 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 business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business 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 when the file is available, <br /> 4. Any file not returned in the same condition as released will be reorganized by Elie staff at the expense of the applicant. <br /> Future file reviews by the same Applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> p D 4x•06 gl13r?.000 wren <br />