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06_/02/2008 06:22 FAX (2002/002 <br />r,= <br />EVN'',[RUNIti1E,N7ALIIE.U..,TIT'DFY.kx ,�YILNT <br />304 E Weber Ave 3`� Floor Stockton, CA, 95205 AUG Q 2 2006 <br />(209) 468-34'?0 Fax: (209) 454,0138 Web: wwv.co.sa;-t Joaquin, a-tu'eENVIR MENT HEALTH <br />PUBLIC RECORDS RELEASE &PPLZCATIOM"/SERVIGES <br />APPUCANT:—M,nl.. M-3fit✓4SUSINESSIAGENCY: 6&Id' •t�# <br />ADDRESS: i <br />f'li4liE: ia FACSIMILE,..tr, <br />TENTATIVE* APPOINTMENT DATE:114cet _Tirrc: !2� <br />(Please allow 14 tw*1nos3 days from date of application submitWI) <br />CHECK BOX TO EXPEDITE REQUEST - 293,00 FEE- REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT ' '� �»_--.-..�. DATE <br />Da,P:trtmant U:,e Only <br />I <br />r <br />UNIT <br />FILE ADDRESS <br />UNDERGROUND? TANK (UST) CLEANUP Sit$ (t.Op) <br />Unit 2 <br />14 -SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (PEON -.OP) <br />n- FOOD FACILITY <br />cry <br />t. <br />;•acct <br />..�+ r <br />� � <br />G <br />s. <br />.tc-ec <br />7CE <br />?d4 <br />❑ TATTO019ODY ME:RCING <br />D Unit 5 <br />M LAND USE APPLICAMON SIT --,5 <br />0 MEDICAL VIAS T F FACILI a f <br />0 OTHER (PLt ASE SPECIF`()__,� <br />��M� ___ <br />6,w <br />G1 <br />r LrirA-.. <br />U9. <br />U0 <br />SUs+ct <br />sn.w <br />OF <br />R t,H„ <br />ON� ..,,.. <br />I <br />r <br />UNIT <br />�q Unit 1 <br />UNDERGROUND? TANK (UST) CLEANUP Sit$ (t.Op) <br />Unit 2 <br />14 -SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (PEON -.OP) <br />n- FOOD FACILITY <br />0 SOLID WAS'T'E VEHICLE <br />UNDERGROUND TANK (MONtTORINGIRF,MOV)t.) <br />Unit 3 <br />M DAIRY <br />HAZARDOUS WASTE GENERATOR <br />Unit 4 <br />o" 1 <br />13 TIERED PE;RWTTED FACiL T'Y <br />Cl MOTEU14OTEL <br />G PUMPER T RUCKIYARDICH h4 TOILETS <br />❑ TATTO019ODY ME:RCING <br />D Unit 5 <br />M LAND USE APPLICAMON SIT --,5 <br />1. List tip to ten addresses in the space above. Select the type(a) of files from the list above b.y checking <br />the appropriate box(es). At least one rile type MUST be selected. Fax to (2091 4 i4-0138 or mall to the <br />addros: indicated above <br />2. EHL) will notify the applicant if any EHD riles exist. An appointment for review will be confirmed <br />approximately five buslnos}s days but no later than tett (10) days after receipt of application, The file.; <br />will be held for a maximum of five business days for review. Appointments should be schedul4d <br />accordingly. <br />3, A rile that is actively being worked on by EHD staff may not be immediately available for review. A neve <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 utAff at the axpenSC <br />of the applicant, Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />5. "TENTATtV'E appointment dates must be confirmed with EHEC staff. <br />6. Applications received after 3:00 pm will be processed the rsext business day. <br />"ONF.1.RMEI3 PE?AOlN'l'MENT DATE' :�� • _ .» ` TIME �5 `:M ._.�._. .. , �•� <br />bATC GfJNFIRMCD PHONE:; FAX' INITIALS <br />REVIEWED YEv NO REVIEV'd DATE _ <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND? TANK (UST) CLEANUP Sit$ (t.Op) <br />C3 HOUSING ABATEMENT <br />14 -SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (PEON -.OP) <br />n- FOOD FACILITY <br />0 SOLID WAS'T'E VEHICLE <br />UNDERGROUND TANK (MONtTORINGIRF,MOV)t.) <br />❑ DOG iCENNEt. <br />M DAIRY <br />HAZARDOUS WASTE GENERATOR <br />L-1 CHICKEN RANCH <br />6- PKC; TREATMENT PLANT <br />13 TIERED PE;RWTTED FACiL T'Y <br />Cl MOTEU14OTEL <br />G PUMPER T RUCKIYARDICH h4 TOILETS <br />❑ TATTO019ODY ME:RCING <br />0 POOE.,!$PA <br />M LAND USE APPLICAMON SIT --,5 <br />0 MEDICAL VIAS T F FACILI a f <br />0 OTHER (PLt ASE SPECIF`()__,� <br />��M� ___ <br />1. List tip to ten addresses in the space above. Select the type(a) of files from the list above b.y checking <br />the appropriate box(es). At least one rile type MUST be selected. Fax to (2091 4 i4-0138 or mall to the <br />addros: indicated above <br />2. EHL) will notify the applicant if any EHD riles exist. An appointment for review will be confirmed <br />approximately five buslnos}s days but no later than tett (10) days after receipt of application, The file.; <br />will be held for a maximum of five business days for review. Appointments should be schedul4d <br />accordingly. <br />3, A rile that is actively being worked on by EHD staff may not be immediately available for review. A neve <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 utAff at the axpenSC <br />of the applicant, Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />5. "TENTATtV'E appointment dates must be confirmed with EHEC staff. <br />6. Applications received after 3:00 pm will be processed the rsext business day. <br />"ONF.1.RMEI3 PE?AOlN'l'MENT DATE' :�� • _ .» ` TIME �5 `:M ._.�._. .. , �•� <br />bATC GfJNFIRMCD PHONE:; FAX' INITIALS <br />REVIEWED YEv NO REVIEV'd DATE _ <br />