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Urj 01, <br /> I 1 <br /> �j EHD LOG NUMBER <br /> SAN JOAQM COUNTY 1 <br /> ENVIRON1WrENTAL REALTH DEPAATMEENT <br /> 304 East Weber Avenue,3''Floor,Stockton,CA 95202-2708 <br /> Telephone., (209)468-3420 Fax:(209)464-0138 Web!www.sjgov.org/ehd I q5P <br /> PE ;1y't"i;S VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: fr A P— _ryG (,[M[) _ 6USINESSIAGENCY: � � Cowyu ns <br /> ADDRESS" - l I WCX/fS� <br /> PHONE(1):��I 0— &a —+/w � <br /> TENTATIVE*APPOINTMENT DATE:�am Trne: V <br /> (Plea3e allow 10 business days from data of application Submittal-"tentarfm only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU T•$93.°0 FEE(CAS R CHECK ONLY):REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - l' OATE I <br /> UNrr:DlSTRISUTION O Unit 1 O Unit 2 D Unit 4 D Unit 4 ❑Unit 5 It Unit 6 0 Other(electronicillsts/maps). <br /> ,[ FILE ADDRESS EHD USE ONLY <br /> 01— Street 0 Street Nano City <br /> 1. .5 , <br /> of-- 2. <br /> 4- <br /> 4. <br /> . ,� �4 <br /> 6.7. <br /> Specific Date Range of Information Requested:From f to <br /> ENVIRONMENTAL HEALT11 pEPARTMEkT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITe(LOP) ❑Housima ADATEmENT 0 SOLID WASTE FACILFTYIVEHICLF <br /> XOTHER CLEANUP SITE(NON.LOP) ❑FooD FACILITY ! G WASTE TrFtz <br /> X UNDEROFtouND TANK(MONITOMNGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDGUs WASTE GENERATOR 0 CHICKFA RANCH ❑WASTEWATER TREATMENT PLANT <br /> Cl TIERED PERI<NTTEO FACILITY 0 MOTELINOTEL ❑PUMPER TRUCKIYARDICHEM ToRkis <br /> 0 TATTOoIB4DY PIERCING Cl POOLISPA � D LAND USE APPLiCATIQN Slims <br /> Cl a <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPnc PpRmrr RECORD&ARE AvAiLAnLE FoR RLME'W- MONDAY-FRIDAY S:00 AM$:OIIPM - EXCLUDING HOLIDAYS. ..., <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to R464-0138 or mall to the address <br /> Indicated,above. Address ranges will not be accepted—tor additional assistance with file addresses,contact <br /> the EHD.Applicatlons received after 3:00 pm will be processed the next business day, i <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed ! <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business I <br /> days for revlow. Appointments should be scheduled accordingly. i <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. I <br /> 4, Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the j <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 'I <br /> END 4842406 <br /> tnMos <br /> min �f <br /> (INV'IHVO Y1tLLVN0E[D TVTt• C99 OTS XVd 90:VT IvS SO/6T/TT <br /> �F <br />