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G,4/Lb/2005 16:29 2096342883 <br /> FEDEXKINKOS PAGE 02/02 <br /> DATE RECErvED • <br /> nnDrI SAN JOAQunv COUNTY EHD LOO NUMBER <br /> W ! Eu VE© EII IIMoNmKNTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3"Floor,Stockton,CA 95202-2708 / -7 <br /> FFR 5 705 Ttdephoae:(209)468-3420 Fax: (209)464-0138 Web:wwvv,jgov.org/ehd <br /> ENRnrvr Nr iaFr_i ry PUBLIC RECORDS RELEASE"PLICATION <br /> FI_ LlhniitrRVl V w` ' <br /> �. C7 6USINESSIAOHNCY: <br /> ADDRESS: k L`NV1✓O'k L <br /> �"� r U (`k+rloclt CA `2S BZ <br /> PHONE 0);�ctp 7'�S'- (6SN te(2): 2s'�g 6410 <br /> FACSNAII.E: <br /> TENTATIVE*AppoiNTIWNr OATS: ']7 <br /> (PkMe WIDW 10 bealness days.. date ofTkne'. b 9—U`�} — <br /> wWsebDD=x MMsi-•TonpoWe Only-mwt be Owdrmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$63.00 FEE(CASH OR CHECK O!R REQUEST PRocessED u1 a <br /> SIGNATURE OF APPUCANT _Ly2 ���/� B NEss DAYS <br /> DATE lyjdl <br /> UNIT DISTRIBUiN)N A UnN 1 ❑Udt 2 C]UTtit 3 G"4 ❑ <br /> thJl6 ❑ llnNe O giber(eketrordGrstshnat+R) <br /> FILE ADDRESS <br /> strw SLeae Name City EHD USE ONLY <br /> t^ Si <br /> 2. <br /> 3. o EcC1 fv <br /> r <br /> 4. W r s <br /> 5. <br /> R <br /> spectlk Date Range Of lnfomration Rego w:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WUMEWRWND <br /> ❑OTHER CLEA NP Sne 1NON-Lop) UP SITE(IAP) 0 HOITawG AaATMENT ❑So WASTE FAcaIRAhgRI,-LC <br /> ❑UNDDTOROUNO TANK ❑FDOo FACILITY ❑WASTE Tar <br /> (M WOOR01O)RENOVAL) O DOG Kno <br /> ❑HAlARDOLE WASTE OR ❑DA+RY <br /> OrmD ATOR ❑eH14110=M RANdI <br /> ^TT0 TPERa p& FACILITY ❑IOOTEIAMOTII 13WAaTQWATOk TREATMENT p"W <br /> ❑MEDICALWAstE Fp AarDY 0 PoO1 A ❑LANG Osa MPUaATTta�m�� <br /> �g+(PLrASEseeca�r) <br /> W5'Ara SSEPm PPOTT RamRD4 ARE AvARASU FOR RrVIEW- N1oN yA AAk"8:00J1104! pt . <br /> 1. List up to ten address"in the smi `DD1n0 HOL�� <br /> appropHate tees). At least one file above. erect the type(s)of Tiles from the list above by checking the <br /> type MUST be selected. Fax to 120414540138 or mail to the address <br /> indicated above. Address ranges will not be <br /> the END.Applications reeelved atter 3:00prn —for eddrhonal assHstalf a write file addresses,contact <br /> 2. The EHD will notify ha will the next business day. <br /> will <br /> aheroWly O tl tapplicant if any EHD 11106 exist An appointment for review will be confirmed <br /> ( )days an"receipt of appllcatloTl. The files will beIte1d fol a metkrress <br /> imum of flue busl <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is 801"being Worked On by EHD staff may not be immediately <br /> application may be submitted when the flle Is available, available <br /> tar review. A new <br /> 4. Any file not returned in the same condition as rekAsed will be <br /> applicant Future file reviews by the same applicant reorganized a EHD staff at the expense Of the <br /> may require a$93.00 deposit prior to revieW. <br /> t:nuraawoe <br /> tnrnx <br /> I <br /> V <br />