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ENVIRONMENTAL TH DEP NT <br />.6 a 1g; <br />S 2 2Q0 304 E Welxrr Ave 3 Floor Stockton, CA 95205 AF a <br />209) 468-3420 Fax: (209) 464-0138Web: www.co.san-joaquincams/chd <br />ENVIRC;,' ""it N I HEALM <br />PERP010 <br />O'1- SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: i7tf-40 ' BUS E CY: <br />ADDRESS: 'S32t Powsernr� +�.o..d. , $+..� /3eo j C��oo.--•cM �'-b tq t} �Q, Z(a <br />PHONE. S lie - Li! a - $134 FA LE: <br />TENTATIVE* APPOINTMENT DATE: i o« o Z• 0'4 Tune: OR 0 `� <br />(Plaasa allow 10 bushmn days fnm data of application submlltan <br />C3 CHECK BOX To EXPEDITE REQUEST - $93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE <br />ENVIRONMENTAL <br />.fly <br />❑ Unit 2 10 - <br />Unit 3 <br />AUnK4 <br />M UNDERGROUND TANK OM CLEANUP SUE (LOP) <br />0 HOUSING A13ATEMENT <br />JA SOLID WASTE FACILITY <br />IS OTHER M.EANUP SM (MON-LOP) <br />M FOODFACILITY <br />0380 UD WA STEVEHICLE <br />iR UNDERGROUND TANK POWrOMNSIREINIOVAL) <br />0 DOG KENNEL <br />03 DAIRY <br />122 HAZARDOUS WASTE GENERATOR <br />C3 CHICKEN RANCH <br />103 PKG TREATMENT PLANT <br />; <br />It TIERED PERMITTED FACILITY <br />13 MOTELINOTEL <br />E3 PUAFM TRUCKIYARDICHEM TOILETS <br />0 TATTOWBODY PIERCING <br />13 POOLISPA <br />0 LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY <br />M OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above, Soled the type($) of files from the list above by checking <br />the appropriate box(es). At least one fide type MUST be selected. Fax to (209) 464-0138 or mall to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of application. The files <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new <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 <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />6. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3A0 pm Will be processed the next business day. <br />'moi:. ,. .• � .r ,.. .n:l <br />YE <br />MOM <br />may. •.... • :�.t ' :: <br />aimm I`.150- t ft /vsM c�a� T�,rng ss, an �ass�l�te c ss Q57S Va cla, y.o trot <br />q-'o-Olf. Fel#alp u/ii F Z TOTAL P.01 <br />