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DATE RECEIVED EHD LOG NUMBER <br /> • SAN ,1OAQUIN COUNTY <br /> RC vi ck ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 600 East Main St Stockton, CA 95207R30P9 Ck <br /> ,�Q i I Telephone: (20.9)468-3420 Fax: (200)4"0138 Web. www'.sjgtyv..orglehdk 01 <br /> PUBLIC RECORDS RELEASE APPLICATION. <br /> APPLICANT:-Lo, Svp 0\C 1( ib'5 RUMNESSIA01ENCY:_ CeAc, FoV(2an�/nom <br /> ADDRESS: c� CiTY/STATE/ZIP:; <br /> PHONE (1): 510 3.L}-7 - 19Qb5 PHdNE(2) 0 -062. PACSIMIL.EC51P �`�(�`�j `1. <br /> TENTATIVE*APPOINTMENT DATE:, 2. Time. i [Lz O A-tYl <br /> (Piease allow 10 buainess.days from date of application submittal-'" entaflvveon -must be Confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ E 125 FEE(CASH OR CHECK ONLY) REQ ST PROCESSED IN 3'BOSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE j Z7 ZU Z <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Stroet Name City _ Unit 1, <br /> DV- 40 RuTo -- L __.. <br /> �Z p � TRA 04 <br /> J ✓ 1 �__ —f ��. _ ... C1 Unit 2. <br /> 3. 3 bc)c) Rum �Azh- _4 <br /> 4. , <br /> -- - --- --__--,--------------------------_._._.___� ,1..7 Unit 3 / <br /> 5. -- (o <br /> 6. <br /> —.—_- ------- Untt d 17/ <br /> --- <br /> --- — --- ❑unitz <br /> 9< <br /> ❑Unit e: <br /> Spndflc Date Range:df NforioMlon Requested: From to <br /> ENVIROWENTAL:�HEALT DDEPARTMENT FILES <br /> ❑LINDERGROLIND TANK(UST)CLEANUP SITE(LOP) ❑HUUSIlia Ao;ATEMENT El SOLID WASTE'FACILTTYNEHICLE <br /> OTHER Ci t ANUP SIT> {N6"OP) F 6o FACILITYHDAIRY <br /> WASTE TIRE <br /> WI <br /> ❑ ERRfROW TAkK(M*Nt ORINdXtjWOVAL) DOG KEL I <br /> B-HAMOWS WAST9 GVNERATDRO�, CHICKEN RANCH ❑WA,MWATERT11EATMENT PLAxr - <br /> ❑TIERWPERMi.TED'FAciury M&EiMditL ❑PWPER TRUCVJYARDMHEWCAL ToCETSI� <br /> [j TgT7QQIBODY PII RGING. ❑ 8PA ❑LAND USE ARRLICATiDN SITES <br /> El MEOICAt;WAST.E.FACILRY Cc►iA AtNr.Redottos, ❑Oflft R(PL€ASE;SPECIFY) <br /> WELL AND SEPTIC PE►2MIT RtcoRgS ARE AVAILiAEiLE;FOtt,FitOiM: MbP1D�RY� RtDAY.$QO.AM-,�;OOOM(EXCLIyI)iNG HOI:IDAY9� <br /> 1. List ua to ten addresses In tfia space a0ve. Select the types)of files froth,the list above by checking. oAppropHate <br /> box(es).. At least'one file too M.LIST be selected; fax.tn l2fJ91 Ad"JM g''mail WAhe gdd�ss Id�it�ated above . Address <br /> ranges will not be atcepted-for additional a;ststance with file addresses,conta6(the'i-HD. Applications received after <br /> 3:00 pm Will:be processed the next business day. <br /> 2. The EHD wili.notifythe applicant if any EHO files exist-. An appointment for review will be.confirmed approximately ten(10) <br /> days after recelpt'of appilcation'. The files Wail behold for 6'rri6dmurh of five business days for review. Appointments <br /> should bo scheduled.accordingly. <br /> A <br /> 3. file that is actively being Worked on by EHD staff may.neat be.lmmedtately available for review- A new application may be <br /> submmed'when the Owls <br /> 4: Any file not retumed 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 appiicant may ticitAre a$125doposlt"prigr to.revs.". <br /> ttir;it5s nnu;v. <br /> D 4.e,p 811/1 <br />