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j I� ��1�uv`'��ijN fy'" ni rMUG BE <br /> tnu LOG NUMBER <br /> '' I cbcr Av cine, FIEAI,Tii bEPARTN -,{T <br /> 304 Ens, .✓cbcr Ave[ue, 3"P100r, Stockton, CA 95202-2708 <br /> " Telephonc: (209)468-3420 Fax: 209 4 4, /�/ <br /> ,r ( ) 6 0138 Web; wHwsjgay.org ehd z3W 57 <br /> PUBLIC RECORpS RELEASE APPLICATION <br /> APPLICANT: <br /> ADDRESS: Ili LONE Pq BUSINESSIAGENCY: TC b <br /> PHONE(�19 <br /> .5'1 ,• l M eyg A SSOCt _ <br /> a �n n I ,^ .CITY E <br /> PHONE(7); $TA7E-C-.�__ <br /> TENTATIVE"APPOINTMENTA FACSIMILE; 26q.Cj c(.Z - <br /> (Pleau anew t0business <br /> days ZI.Q b <br /> YE om date o!aPplicatlonaLtNninel, Time: <br /> 4 CHECK BOX TO EXPED{TE REQUEST- only.must be cpmrmed� <br /> — <br /> SIGNATURE OF APPLICANT ffJ.00 FEE(CASH OR "I'"CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> Ekctro^k <br /> 7 Q(� <br /> 1^FomlaUon Lyt O MaPDATE-OHcriptiOn --�--- <br /> street III FILE ADDRESS <br /> �Jll 1 Strati Name <br /> Cou U city END USE ONLY <br /> 2. 2 OS C <br /> 3 2 t ❑ Unit 1 <br /> 5 Zzt T O Unit 2 <br /> 6. <br /> e. Unit 3 \1 <br /> 70' O Unit 5 <br /> Specific Date Range of Information Requested; From0 Unit 6 <br /> —PAST to _ AV A 1 l q&t <br /> ENVIRpNM -NTAL HEALTH DEPARTMENT FILES <br /> 1qUNDERGRGUNDTANK(UST)CLEANUP SITE(LOP) <br /> 01NIR CLEANUP Sire(WON-LOP) b HCUSIRC AGATEMENT <br /> C UNDERGROUND TANK(MONITOIIINWREMOyAI l7$OUO WASTE FACILITwvENIDLE <br /> d F000 FArxm t7 WASTE 71itE <br /> /- HAEAaDOUS WASTE GENERATOR ) O DOC KENNEL d DAIRY <br /> TIERED PERNITIED FACILITY b CHICKEN RANCH <br /> TATb WASTEWATER TREATMENT PLANT <br /> TOOftDYPIERCING OMOTtL/HOTEL CTPASTERTR <br /> ID MEDICAL WASTE FACIUrf b POOLISPA ucK7YARO1CNEM4AL TOILETS <br /> b OMAR(PLEASE SPECIFY) p LAND Use APPL1CAnON BITES <br /> WELL AND SEPTIC PERSaT RECORDS AAS AVAAAeLE FOR REv(Ew-MONOAYfR10AY I:De/W-E:GDPM - EkCLUgNG HOLIDAYS, <br /> t, List up to ten addresses in the space above. Select the types) of files from the Ilst above by checking the <br /> appropriate bOX(es). At least one file type MUST be selected. Fax to 203 4°4.0 <br /> indicated eve. Address ranges w01 not be accepted-far additional assistance with f E138 or il to Lh�dess <br /> addresses,contact <br /> the END,Applications received after 3:00 pm will be processed the next business day. <br /> 2. The <br /> approximately <br /> will notify the days <br /> after <br /> ant receipt any EHD files exist. An appointment for review wilt be confirmed <br /> days fornreview eApp°ointmen s Should be scheduled ac oro gl10s will be held for a maximum of five business <br /> 3. A file that is actively being worked on by END staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released Will be reorganized by END star at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> TW- <br /> END 4" .— -"----• <br /> 16n112"6 <br />