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Nov 28 05 03:26p Apex 2C X67-9668 p . 1 <br /> TERECEIVED- - - <br /> It \ `,/i t 1 SAP) ,JO,A,QUIN COUNTY EHD LOG NUMBER <br /> � I � 1�& �� u Lr Lei <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209) 468m3420 Fax: (209) 464 0138 Web: www.sjgov.org/ehd <br /> - RTES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Dr(W QW 1 -P- A BUSINESSlAGENCY: �('� <br /> ADDRESS: i1co IA'k'y �+ }a JIV'C. =orflJl Llc rj, 5' 7 'Q i - <br /> PHONE (t): Z* 1 LLQ - tra1 PHONe (2); FACSIMLE 16 1% 46b � <br /> TENTATIVE" APPOINTMENT DATE: 1 Z f �l� Tine C7 Q lA <br /> (Please allow 10 business days from data of application submittal a *TenQaave only _ must be eooflmwd) <br /> CHECK BOX TO EXPEOrTE REQUEST - $93.00 FdEECASH OR CNECK ONLY) - REQUEST PROCESSED IN 3USI DAYS <br /> SIGNATURE OFAPPLICANT DI'a^- U- ` DATE ll �Z4! 4)r <br /> UNIT DISTRIBUTION QUnit 1 0Unit 2 0Unit 3 - Aunit4 ❑ Units O unit ❑ O"ier (electronicaiswmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street A street Hame city <br /> 1 . ya . s p4a ; w r+- <br /> 2 a7, mss+ L#* &4V Sl.+cx 4; ) t/ <br /> lLS Sat btk "44 SL X957 <br /> 6. (L.( CS 1 Jwtia. L - tx 6n 35 7 �. 0 <br /> 7. 1131 LMJ Y tk -4 , /_, n <br /> 341 3 . 6?• J tr s Y � � -a � N tG <br /> Specific Date Range of Information Requested: From 'Z.�y to irJ trta <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> N602DERGROUNDTANK (UST) CLEANUP SITE (LOP) O Hausim ABATFlMT E3 Souo WASTe FAcam1VERICLE <br /> ❑ OTHER CLEANUP SITE (140144L013) ❑ F000 FACIUm 13 WASTE TRE <br /> UNDERGROUND TANK (MONLORINGIREWWAL) Q DoGKaels E3 D=y <br /> 13 HAZARDous WASTE GENERATOR 13CHCxENRANCN - O wASTewArm TwATMtM PLANT <br /> O TEFEO PERMRTEn FAoum 13 MOTEUHOTeL 13 PUMPER Tia. KJYARDICmEM TOILEM <br /> ❑ TATTDo/BOUY PiE=NG ❑ POOLISPA 13 LAND USE APPLICATION SuM <br /> MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br /> WELLAND SEPTIC PERIWTRECORDS ARE AVAILABLErOR ROnEW - MONDAY-FRIDAY8:00 ALLL:00PM - EKCLUMGHOLp M <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the fist above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mal( to the address <br /> indicated above. Address ranges will not be accepted - for additional assistance with file addresses, contact <br /> the EHD. Applications received after 3:00 pm WIN be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files wrist An appointment for review wilt be confirmed <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five 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 /> 4. Any file not returned in the same condition as released will be reorganized 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 /> BxOmmoos <br /> 111aB5 <br />