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06/22/2007 11:49 131079FOR41 PAGE 02 <br /> pATd <br /> EHD LOG NUMBER <br /> ' SAN JO.A,QUIN COUNTY <br /> L'1 <br /> 1 � 1`-'�x��i tt � <br /> ENVIRONMENTAL HEALTH DEPARTMEW 3 <br /> j Q N' - 2 2007 600 E.Main Stmt,Stockton,CA 95202-3029 <br /> Tekphene:(209)468,3420 Fax:(209)464-0138 Web:www.sjSoy-oq/ehd <br /> PEEN!,fi/SE:RVICES��P�UBLIC RECORDS RELEASE APPLICATION <br /> APPl1CAtdT: &Olt susiHEmA®ENcy. AM -4 Z e-Ai <br /> ADDRESS: C'f-C'eA y`.•CA PHONE(t): _C9.r. 4c 2.77"1-___-- PHONE(2): _ Y� - �� ^h72- FACSWIL.E: <br /> TENTATIVE*APPOiNTMENT DATE: Time: <br /> (Plaine allow 10 busin"s dsp fmm lots of spplication eubmlttal-"Tarr gm only-must bo confirmed) <br /> ® cHEcK sox TO ExPEorre REcsm fi. (CASH Y)-REQUEST PROCESSED DI 3 BUTES,DAYS <br /> Si[INATURE OF APPI-CANT DATE 6 "Z-/y --- <br /> Elrectrunic hifC."Tnafton: [j t_Ist[]Map—Dessariptlon: <br /> RLE ADDREW EHD USE ONLY <br /> 13taeet E 911 New City ❑ LMR 1 <br /> 1. 5 + ,r- <br /> r Y. <br /> 2. Unit 2 <br /> c <br /> 8. <br /> 4. Unit 3 <br /> Unit 4 <br /> 6. <br /> T. <br /> Q. ❑ Unit 5 <br /> g' Unfs fl <br /> 10. <br /> apeolfic Date Range of Information Requested:From to <br /> ENViRONMENTAL HEALTH DEPARTMENT FIi,ES <br /> 1161Nl eotaa TANK(UST)CuAm P SRR(LOP) HOtmwe ADATIMENT . sow wAOTB FAc LRY vonow <br /> 15OTMMt <br /> coup an piam OP) O FOOD FAORM 0 WASiE TWE <br /> tNlsaRs KUK)TAW Dos PMNNEL 0 DAIRY <br /> HAZARDOUS WASTE QW&MATOR t CNrs M PAWN ;WWAM-WATER TMATMi2NT PLANT <br /> 13 ATiOM PKIR 0 PeoM�A e PUMPER APKICATM SITES <br /> Tors�Tg <br /> 13 MEr I AL WASTE FAc ny 13 OTNEft(PL"W SPECiPy) <br /> WELL AND 8Wn1c PEMW RacuM ARE AVAILABLE POR Raysiw- MonoAy*RmAy 6:6e Amz-W M - ExcLuo is HaiDAy& <br /> I. tst up to ten addresses In the space above. Select the"(a)of Ales from the M above by checking the ooproprlame <br /> box(es). At least one file type MUST be selected. Fax to(4091 MM4 RIN or M"-the A m" Icaw MOMS Address <br /> ranges wW not be accepted—for additional assistance with file addresses,carftct the END.Applications received after <br /> 3:00 tarn will be processed the next business day. <br /> 2. The Elft will notify the appllewt It any END files exist An appointment for review will be confirmed approxlmetely fort(10) <br /> days after receipt of application. The files will be hold for a maximum of five business days for review. Appointments <br /> IbmAd be scheduled aocordhVly. <br /> 3. A fit VW Is actively being worlmd on by END staff may not be immediately available for review. A new application may be <br /> submitted when the file to available. <br /> 4. Arty file not returned in the mama condition as released will be reorganized by END staff m the expense of the applicant <br /> Future fit nrA& s by Om some applicant may require a$9&00 deposit prior to review. <br /> EHD USE ONLY <br /> em*14K WiWAN wee <br />