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* 10g3,� 2094626171 STOCKTON PETROLEUM C PAGE 01 <br /> . r•c i} r-No LOG NUMBF r <br /> SAN JOAQUIN COUNTY � <br /> I SUP` ,, 2m. ENVIRONMENTAL HEALTH DEPARTMENT <br /> I 304 E Weber Ave 3rd Maar Stockton',"CA 95205 <br /> ENV1f NMENTHL ; _3420 Fax: (209)x364-0138 Web: www.co.san-joaquin.ca.us/eho <br /> j PUBLIC RECORDS RELEASE APPLICATION <br /> i APPLICANT: : 1, BUSINESS/AGENCY: P <br /> I ADORESS <br /> PHONE- 6? 15 L FACSIMILE: <br /> Y7�rbA-- - 7 v7 <br /> T` NTATIV 'APPOINTMENT DATE: Z�' Is Time. i <br /> I h <br /> (Please allow 10 business days from date of application aLbmittal) <br /> it <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—REQUEST PROCESSED IN 3'SUSINESS DAYS <br /> SIGNATURE OF APPLICANT / Ii DATE <br /> Department Use Only <br /> t`{ FILE ADDRESS I N UNIT <br /> Ci f : ' cII�.Z o/ V r fl f -Unit 1 <br /> c A <br /> Street t• CI �--r S <br /> J. Sl,., 190 (� .. $ YVI <br /> [� Unit 2 <br /> f.(r.:%i` .1 sea Q. ❑. _ c�, f'l . . ! V 1� 5 L7 <br /> �.i�. 5. Srreel —•---- Ci I� t V <br /> t„ Unit 3 <br /> Iii reel <br /> cityIr <br /> r. srreA Il Unit 4 <br /> 6. Sweet dry ` <br /> C 9. s°�e, City Unit S <br /> i <br /> ,o. 5,r•u <br /> City <br /> 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT I=1LES <br /> I' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(IAP) ❑ HOUSING ABATEMENT El SOLID WASTE FACILITY <br /> i OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONFTORINGIREMOVAL) 1] DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR C1 CHICKEN RANCH 0 PK G TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> �. TATTOOIBODY PIERCING 0 POOUSPA { C1 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above.'Select the type(s) of files from the list above by checkinc <br /> r the appropriate box(es). At least one file type MUST be selected. fax to (209)454-0'438 or mall to the <br /> address Indicated ail v . 11 <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 bf 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 EHD staff may not be Immediately available for review. A ne, <br /> I` application may be submitted when the file Is available. <br /> I 4. Any file not returned In the same condition as released Will be reorganized by EHD staff at the expans <br /> of the applicant. Future file reviews by the same applicant ri'tay require a$93-00 deposit prior to revie, <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff: <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> �i <br /> DATE CONFIRMED PHONE FAX IN171ALS '. <br /> it <br /> REVIEWED YES NO REVIEW iDATE.� <br /> EMU 4"2096 ..—'--- -- <br />!ll ersrtaoa <br /> j I <br />