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May, 11, 2007 9. 37AM Ad ,ed GeoEnvironmental U, 8568 P. 1 <br /> ►1[ <br /> DATE RECEIVED EMG LOG NUMBER <br /> J0 AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3"1 Floor, Stockton, CA 95202-2708 � <br /> Telephone: (209) 468-3420 Fax.- (209)464-0138 Web: w-vvw.sj00V.Or ' d <br /> PUBLIC APPLICATION <br /> RELEASE APPLICATIO <br /> APPLICANT: rSU BUSINESS/AGENCY: 1Q1 <br /> p <br /> ADDRESS, O JC Q m C.L g) v� <br /> PHONE(1): 40- Y&7- 1-006 _PHONE(2). Q -a� / —FACSIMILE:a74��y10 <br /> TENTATIVE*APPOINTMENT DATE; '6gooTlms: .M <br /> (Please allow 10 business days from date of a llcbtlon submittal-`rentatrve only-must be conflrmad) <br /> CHECK BOX TO EXPEDITE QUEST-$95.00 FEE( H OR HECK ONLY)-REQUEST PROCESSED IN 3 BU§JNE33 DAYS <br /> SIG <br /> AT <br /> OF APPLICANT DATE <br /> Electronic Information: ❑ List LIMap—Description: <br /> FILE ADDRESS EHD USE ONLY _ <br /> Street# street Name City ❑ <br /> Unit 1 <br /> �• ov � Cit s t.v <br /> 2. 330 ❑ Unit2 <br /> 3. <br /> 4. Unit 9 O <br /> 5. I <br /> 6. ---/— <br /> - - Unit 4 <br /> 7. <br /> e ❑ Unit 5 , <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES O <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) -HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> �Q OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR En CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> C1 TATTOOIBODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- 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)464.0135 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 EHD 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 /> 9=111111IMMM <br /> END 48-08 S/13i2��6ILM <br />