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05/03/2005 14:50 70745284, JEAN HUGHES PAGE 01 <br /> . t_NV iNL>r?Pn_N I AL HLf PAGL 01 <br /> C� UATF RECEIVED <br /> ❑ SAN JOAQUIN COUNTY L'nV Lov r4umbrm <br /> ENWPONMENTAL HICALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 17 <br /> MAY 0 3 ?OR�lephone: (209)468-3420 Fax: (209)464.0138 Web: www.3jgov.org/chd <br /> ENVARONMENT HEALTPIU LIC RECORDS RELEASE APPLICATION <br /> 7A,'DVRE3S; <br /> T: <br /> eusrNEs�AaE,+cv: <br /> PHONE(7): 15a•lag 13 <br /> TENTATIVE`APPOINTMENT DATE: _� � � Tim, <br /> (Plass*allow 10 buslnssa days frprm dab of appllvvtiun av -'Timotiva only•must 0 vvntlnntt) <br /> ❑ CHKrK AOX TO EXP15DITIE FmpUE8T.N].t)0 FE fA3H ORMECK ONLY)•FMQUEST PROCESSED IN 7 ruspiss DAYS <br /> SIGNATURE OF APPLICANT DATE INOS <br /> UNIT DISTRIM TION n Unit 1 nit Z O Unit 3 nit i n Untt d ❑ Unit 4 ❑ Other(vWctronlol q%/mipt) <br /> FILE ADDRESS EHD USE ONLY <br /> \ Strwt N $tract NomC <br /> V <br /> mhi <br /> 10 a � <br /> Specific Date Range of Information Ftequssted:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0L1NptlkoRvvW TANK(UST)CLOLMP SIT;(LAP) 0 Piousm AaATIMaxT Q SOLID WASTS FACX"tYIMICL■ <br /> El OTMIR CLCANur'SITt(NON-LOP) 0 Foos FAGIUTY M WA$T4 TIRE 1 <br /> *0MUJ"WPt9P0UN0 TANK IMONM IN"IMOVAI.) TI Doe KaRmt, krPMva*rwm <br /> _MAZAIRD"WAan CilNIRATQR n CMIO►�N RANCM WrATa0.TRIATMaNT PLANT <br /> CI naftED P[RMrr ao FACUTY 0 MorvLgioml TRUGWYARorCMIM TMIFTf <br /> C3 TATr001600Y MIFRC(No O POOLMPA CI Usa R ATION s(TWO p, <br /> D WncAL WAST[FAC+UTY VIQ N Vl(PLIAS*aF5CIFT) <br /> WAIL AND SVTIC P"14T RjjCQR01 AAA AVAILABLK FOR REVIEW - mok"Y-FIRIP y!. _S:00rM - RxCLWINO HOLIDAYS. <br /> 1. List up to too addresses in the apace above. Select the type(a) of Elba from the list above by checking the <br /> appropriate box(es). At bast one file typo MUST be selected. Fax to jZ091484 r ail to t114 addre s <br /> Indicated s�4Ytt, Address range=will not be accepted—for additional assistance with file alddresstra, contact <br /> (11e E141),Appllcatlons fW ecaivpd after 3' pm will be processed the next buslneea day. ' <br /> 2. The EHO will notify the applicant If any!HD file*exist. An appointment for review will be confimwd <br /> opproximaitely ton (10)days after receipt of application. The files will be held for a n►aximurn of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is activoly being worked on by EHA staff may not be immediately available for review. A new <br /> application may be s0mitted'when the Me Is available. <br /> 4, Any fUe not returned in the some Dondt lon ata released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the some applicant may roquiry a $83.00 depoelt prior to review, <br /> IkD Aa•u2•onF <br />