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DEC-28-2005 WED 10142 AM FAX N0, P. 01/01 <br /> MTE RECE EHD LOG NUMDER <br /> �11`v vSAN ENVII20NMENTAL HFAI,H D TIN ARTMEN'I' <br /> 20Ur 304 East Weber Avenue,3rd Floor,Stockton,CA 45202-2708 �I <br /> '� s pbowl 009)468.3420 Fez,(2091464-0136 web:www.V&ov.ors/and <br /> ENVIRON ,'-'N l HEALTH <br /> PER.i�il-i -)[.VICES PUBLIC PRCORDS RELEASE APPLICATION <br /> ptlslNE581AGriNCT: Mctc,l n.l 1, Hx,,�1�,.,..�� <br /> APPLICANT: Cl TA <br /> ADDRESS; >NL �- B �1 �6�' <br /> '2 r7Yt1YYJ1 c0.Yl� 3�Vd ,-2vTo110'b� _CrY1 <br /> c '3 PHONE(2): FACSIMILE: CZoct) 4�3``�bl� <br /> PNotn!(Ir �-- 7aoi�.rvn,:_ <br /> T 'F-H l ATNF'APPOINTMENT DATE: ^1A AaX � <br /> (Plow allow 10 bYslnes:days VOM dab W appYcaeon bmltral-•TanoNva only-mUd b'COnfirdlBdl <br /> t7 CNHCK Pok To EVEDiT6 HE W.00 FEE AS CH• ONLY)•R>tQUPaT PROOBSaEO IN i EU$l E DAYS <br /> J <br /> SIGNATURE OF APPLICANT - DATE <br /> InIMAanIC ❑ Uet Q Map`Dead . <br /> FILE ADDRESS EHD USE ONLY y�p� <br /> atroatM 5tv"Hama GI[Y unit J\ <br /> 1. l C � ❑ <br /> 2, a Unit 2 <br /> 1�\ <br /> 5. <br /> 4. KUnft 3 <br /> S. <br /> 6. /Unlit 4 <br /> 6. <br /> 7. ❑ Unit 5 <br /> a; ❑ Unit 6 <br /> 10. <br /> speeifid Date Range of infonnaaen Requested:From - 1-- - tO <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .�/ <br /> M HMINm A6ATMENT C 6060 WAM FA.CLnTIVE4CLE <br /> y�UNDEfAFtOUNDTAOK WST)MJ"P anr(LOP) LI Doo KpFcab PAOILmY CWAm TM <br /> 'TlLovinat OmmuP smiB(NON-i.OP) � ❑DAIRY <br /> IEUWDUKDROLOW TANK(WONITOF0191RM=A1.1 DO NW UL t7 WASTMATO TRPATUMT PLAXT <br /> *HA2"Dus WAM 09KrMTOK ❑Gt%=NR t3 PWIERTRUCKIYARD[CW%I1CALTOI-FIS <br /> *TIFA➢O PeKNmOo PAc"TY it7 LAAID Dae AAPLICAMx 8mm <br /> b R A <br /> P TAMOMODY PrRtmV ❑OTX& (PL <br /> PA9i a ) <br /> CHeDr.AL WA4M FACILITY OR Rpm,. <br /> PIKp/`v a:DO Aa•S:OeMELIDO khhPari. <br /> WELL ANO SgFrc Peon Rv-=s ARC AVALAKS P <br /> 1, List up to ten addrease•In.the space above. rweet the type(a)of files from the list abvmelve l by checkinheaddress <br /> appropriatebox(es). At least one file typo MUST he selected..FAx to 1209)di)4 01 the <br /> or <br /> lndlce b97L4.. Addrae range&Wlil not be ancapted—for additional asalatance with file addresses,contact <br /> the EHD.Applications received after 5:00 pm wIII be ptocessed the next buAness day. <br /> 2. The EHD will notify the applicant If any EMD filoa exist. An appointment for review Will be confirmed <br /> approximately tan(10)days after receipt Of application. The files will be held for a maximum of five bu3innM6 <br /> days for review. Appointments tihould be scheduled accordingly: <br /> 9. A file that Is actively being worked on by EHD staff may not be Immediately avaltable for review. A new <br /> application may be submittod When the file Is available. <br /> 4. Any file not returned In the same condition as roleased will be reorganized by EHD staff at the expense of the <br /> applicant• Future file reviews by the some applicant may require a$95.00 deposit prig to review. <br /> ------------- <br /> Y <br /> F 1 • <br /> GTiD1ASr <br /> M1C/�V]AC6 ' <br /> TB 39tid H179riH '1V1N3•tMIN43 0ET0090 OE:TT 9002/ZZ/ZT <br />