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MAK. r. LUUb 2:7I�m EARTH TECH NO. 5926 P. 2 <br /> rs <br /> J <br /> SAN JOAQUIN COT)TqTy EHD LOG NUM812P <br /> ENvjRoNmNTAL DXPARTMM <br /> ENVIRONIMUM' liEALTH 3304 East Weber Avenue,3 Id Ploor,Stock-ton,CA 95202-2708 <br /> PfRMR_,,kj'--EPLV10ES Telephone:(209)468-3420 Fax:(209)464-0138 Web:www,sjgo-v.org/chd 253 7 <br /> PUBLIC RECORDS RIELESIE APPLICATION <br /> APFLir,ANT., PREA64N SlN AGENCY: <br /> ADDR&Ss; <br /> I (A <br /> PHONE ?HQKE(2): —__FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> wTenft only <br /> v from 4 cation only <br /> (Pleaw allow 10 buginew Clay Tme: <br /> "aoi ii6rjn -must be confirtned) <br /> r3 CHECK Box To RXP RP I <br /> .C:�EDITE RE T.:,3.0 E4 CHECKOINILY) REQUE:SnT PROCESSED IN l3 B71NESS DAYS <br /> SIGNATURE OF APPLIC T DATE <br /> Qto <br /> UNiT DISTRIB <br /> Unit Cl Urfft2 0 Unit Unita 0 Unit$ 0 Unite 0 Other(OlOctronictlL*/maps) <br /> FILE ADDRESS <br /> Strait Street Name EHD USE ONLY <br /> F4. <br /> 4. 1411,Mt <br /> A. <br /> 159 2- MVW.&4- 7-0� <br /> 22 <br /> 7. 7R _13 9 <br /> LO, 4 <br /> 9. <br /> A.). <br /> F <br /> SPectfic Date Ran!*Of Information Reclue3ted:From to <br /> ENVIRONMENTAL HEALTH DEARTMENT FILES <br /> 1 ED <br /> UNDERGROUND TANK(UST)CLEANUP SrM(LOP) E3 HOUSINGASATEM IGOUD WAFM FACamNExicu O, THER CLrANUP SITE(Not4-LOP) 0 FOOD FACILny <br /> SPNDERGROUND TANK(MOMTORINGIRGUOVAL) WAM MRr, <br /> HAZARDOUS WASTE GENERATOR 0 Dor.YZNNSL DARY <br /> 71ERF-D PORMIlTED FAClLrrY C2 CMCKr;N RMCH E3 WASTEWATER TRSATMENT P LANT <br /> IM TATTOWISODY PISROINQ M MOTELMOTEL PUMPER D=rVARDICHEM TVELM <br /> NIODICAL WAS-TE FAOUTY 13POOLMFA LAND USE APPLIOAMm SITESC;OTHER(?LEASE SPECIFY <br /> WELL AND SEPTIC PERMrrFJ-=CORDS ARE AVAILABLE FOR REwEw- Mo DAY 6:00 Am-5:00em - EXCLUDING HouDAys. <br /> 1. List up to ton addresses in the space above. select the typem of riles from the list—above by checking the <br /> appropriate WX(es)- At least one file type MUST be selected! Fax to.(209)4 4-0138 or Mail to the addre�s <br /> Indicated above. Address ranges will not be accepted–for additional assistance with.file addresses,contact <br /> the EMD.Applications received after 3:00 pm will be processed the next business day. <br /> Z The EHD will notify the applicant If any EHD files exist An a <br /> ppointment for review Will be confirmed <br /> approximately.tan(1 0)days after iecelpt of application. The files will be hold for a maximum of five business <br /> days for review. Appointments shotild be scheduled accor4i gly. <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 avallablo. <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 /> L <br /> SHP 4M2.409 <br /> V14W <br />