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Jun 02 06 01: 17p Sie'-a Delta Corp 1 -55929-1452 F . 1 <br /> DATE RMCEWW EMD LOC:NUMBER <br /> SAN.IOAQUIN COUNTY <br /> ENVIRONMENTAL HEAL TH DEPARTMENT <br /> MUM�D <br /> 304 East Weber Avenue,F 3(Floor,Stockton,b: ww,sjg v.or <br /> SUN .2 .2006 Tdcphonc:(209)4G8-3420 Fax:(209)464-0138 Wcb:wwwsjgov.org/ehd <br /> ENViRONMiAl li/iT11 PUBLIC RECORDS RELEASE APPLICATION _ <br /> PERNk R" cr BUSINESSIAGENCY: <br /> ADDRESS:_ S7 /C.(. r,;rr/ S/]z 'f Sy r�'�' /57, , AOA <br /> P14ONE(1): - zz9.- (yam PHONE(2): FAC3111ULE: J <br /> TENTATIVE'APPOINTMENT DATE: &-6­06 Time: `l <br /> (Please allow 10 business days from data of application submfttal-"ren0NVre only-m be contitmad) <br /> C3 CHEEK BOX To EXPEDITE REQUEST-$93.00 FEE(CASH7 CHECK ONLY)-REQUEST PROCESSED IN$BUSINESS DAYS <br /> SIGNATURE OF APPLICANT e-.-+-{- DATE <br /> UNIT OISTRVUMN O Unit 1 19 unit 2 El ural s ❑Unit A O units 0 Unit 8 CI "a(ekwtroniHlistslmeps) �� <br /> FILE ADDRESS EHD USE ONLY <br /> Streat fr Strea.Nam C <br /> 2. / \� <br /> 3. a� <br /> 4. , / <br /> 5. <br /> e. <br /> a. <br /> 10: - <br /> -Sj*C ae Data Range of InTonnaticeL P*quested:From /Q 4[S to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGRCVN0 TANK(UST)CLFANIIPSITE(LAP) C1 HOUSING AHATBABJT $ALIO WASTE FACILGTIV-cHIC <br /> OTHEROUsANUF SIIE(NON{OP) 13 FOOD FAOK.RY 5WASTE TIRE <br /> UryOeCGRCUNn TANK(MONRORINGAEBmOVAL.) O Doo KQINEL E3 DAIRY <br /> HA-"AR000SYPA7rE GUNERATOR O CHICHeN RANCH ❑was m-NA-rm TRH.TInwr PLANT <br /> 13 Timm PETatIFTrA FAcs-nT El moTemOmL C3 PUmPEn TRUCKIYARLYCHm TbiETs <br /> O TAT TOOAlvO Pitnaino Q POO✓SPA 0 LAND Uae APvt. TwN Snes <br /> ❑MEDICALwASTE FACILITY ❑✓r (pLEISESPECIFY) <br /> _ WELL ANO Ssync Pzuea Rrr ra ARF AYAILAoLE FOR Rmiiw- MOWAY-FRIDAY 8:00 Am-5:00Fm - E=Ly uHOumya. _ <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by chedting the <br /> appropriate boxies). At bast one file type MUST be selected. Fax to(209)484-0138 or mail to the address <br /> inliicab!dabove. Address ranges will not be accepted-for additional assistance with Tile addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately avallable for review. A nev.t <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 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 /> 0l0 atzaaa <br /> +Home <br />