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03/57/2006 12:45 4640138 ENVIRWWNTAL FEAL� PAGE 01 <br /> OATS RECENEO EHP LOG NUMatH <br /> SAN JOA.QUIN COU"Y <br /> nc ENVIRONWNTAL HEALTH DEPARTMENT <br /> ( L�aIP� 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 A <br /> Telephone:(209)468-3420 Fax;(209)464-0135 Vhb, www.3j9ov.0rgfehdI�� f( <br /> PUBLIC RECORDS RELEASE APPLICATT.ON <br /> APPLICANT: _., I 5USWSSr ENCY: n <br /> ADDRESS:(L �1�.f1'�f11� Djg lC� cmlftP•Z t)'}— /- .-TALE _ <br /> FACSWIL •" � ' <br /> PHONE(t �a-�7 a�COO PHONE(2):,1� /I b 47r I I <br /> TENTATIlfr APPOINTMENT DATE. <br /> (Please allay 10 bostnew days from dam of RNNCanon auMIttal"TerrtatfVO only'must be cane <br /> ❑ CHECK BOX To RXPEDrM REQUEST-#93,01)FEE(CASH OR CKCK ONLY)•REQUEST PROCBSS5D IN E BUSIMM DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> �/ �0o'OTMF ❑ List M leap-De6pHpNon <br /> fMomladtm <br /> FILE ADDRESS £ND USE ONLY <br /> Shpet d Street Name city <br /> 0 Unit 1 <br /> 2. Ir#= <br /> 3. s i Aa t Unit 2 <br /> 4. 3 Unit .3 <br /> 5. t <br /> s. t °� 1 ' T Unit 4 <br /> 7. 1 ti " <br /> a. ❑ Unit 5 <br /> 9. <br /> 10, Unit 6 <br /> SpeoiRa Date Range of Inf rimation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPA1TfMENT�FIILFS <br /> );INCeR2ROCPOTAMr(USTI CLE,Ww Srta SLOP) .7 HQU91N0 AeATFdtENT /o4�ON7 WAs5c FAa�LiTYNEXPCLE <br /> OTNER CLEANUP Sire fNON-LOQ ❑FOOD FAOM, ^/t-.WASTE TRE <br /> IJNpgRGRCUMC TANK(MONITORINO7REMOVAL) ❑Dao K9NNEL OOAItiY <br /> WAS <br /> TE QiENaRAT� GCHICKm RANCH 9wAETENATER TReATLEi1T PlNtT <br /> TMRI0 PERWr14C FAOn TtY O MUMLiHOTEL 19 PumFm TfWcKr ARWOHCWA.LTOII,ETe <br /> 17Ty�A�TToW13 uYNEROW0 GPO❑UgPA ElLANsUW_APM4QA7,0NSr,E8 <br /> ❑MIMI❑AL W ASTF FACILM ❑CrMtR(PLEASE SPECrrY) <br /> WELL ARD SE"rP6NIRTRECCRCAARE AYAILA=FOR REAM-MONDAY-PRIpAYS:90AWSADM - VAOLLMIMHCLWAYd. <br /> 1, Llct up to ten addresses In the space above. Select the types)of files front the list above by checking the <br /> appropriate box(es). At leant one fife type MUST be selected. Fax to MOM 494:0139 or tq 3 1 to the ad <br /> Indi5W above, Address ranges will not be accepted-for additional Assistance with file addMaes,Wrltant <br /> the EHD,Applications received after3:00 pm will be prooessed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days attar receipt of application. The filen will be held for a maDdmum of fiva 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 available for review. A new <br /> application may be submitted when the file is available. <br /> 6. Any file not returned in the same condition as released will be rzorganlzed 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 /> 7- <br /> 6X068G6 <br /> iM1❑006 <br />