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°`_r29a5 7.5:47 9259442955 TSG PAsC 114 <br /> (OAT RE It e END LOG NUMBER <br /> W I�`rrl�� $ANJOAQUIN COUNTY <br /> EKY V IROMAENTAL HEALTH DEYAR.TmiENT <br /> SEP 2 2 2tY06 304 East Weber Avenue, 3'1 Floor, Stockton;CA 95202-2708 <br /> .�6 phvae; (209)468-3420 Fax:(209)464-0138 Web:vrww.sjgrov,org/em <br /> Z50" <br /> ENVIRONMENT HEJVM PUBLIC PWCORDS RELEASE APPLICATION <br /> ^^-, ------ <br /> APPucatAT:LLq A o ov, BUSINESS/AC:%ENCI: ,wadi�[ _ale.r/_�^'ir4.e, . <br /> -®®�-- <br /> L) Pliom(7): FA?MULE: <br /> T'ENTATIVE"APPOINTmEtr DAT9: Time: <br /> Nloaw akar 10 bwlp„n Jaya from data of applicatlD n subintitel-'remigiva only•must be confirmed) <br /> 17 rhECK BOX TO EXPEbi7E REQUEST•$96.00 FEE(CASH OR CHECK ONLY)-REQUEST FROCESSED IN S SUSINF89 DAYS <br /> OI(3NATUR15 OF APPLIOART __DATE <br /> E(e l;n3n lrtk nnatlon: U i_hlt o Map—Description: P <br /> FILO A1RDF�35 EHD i19E ONLY <br /> stiret9 _ StHame City fit. <br /> �. jolt <br /> of <br /> 3'f�rj It _ t , Ir V <br /> C 4_&,2.klt T 4Pun <br /> , 1 Unita <br /> _.— Cl tines <br /> 9' OR <br /> 10. <br /> Speaid?r.UattRanke oT ifr?orntation..Requested:From _ to _- <br /> ZEMRONMEMTAL HEALTH DEPARTMENT 1711-155 <br /> V-UtinERGROUNII'AN3:JUST}'CLMNMFATE(t.OP) ©Houstmo A@ATUNENT SCLIb WA91E FACa1TYXV C:.[ <br /> nE <br /> .�(C"FR CLEANUP S (NON-LOP) E3 FOOD FAoa �WAar€TIRE <br /> Qt lr'NDERGROVND TANK{IaaNr7OftNGIRE6rOYAlp ©DOG KENNEL Rt[)WRY <br /> 60 HAZARDDVS WASTE GENERATOR V-CHICKEN RANCH RWATrkWATERTNE TMENT PLANr <br /> .'.a(TTcs ?WVF7T.U.FAMTY 17 MOTHIHOTEL ;Q PutlP€RTmacKlyARnMF+eP ToRETs <br /> TG.r+7019 Coy N-rRriNS ©POOL(SPA PLI,.M,VaE AF Ucx,,ON SIM <br /> #4 Nr7w_,�x WASTE FA+w7LT 0OTNm(PL nSPFcvrr7.._ - <br /> 'WgL_ANDsEVTICPfRnRRFoaFDp AREAYA6AramRFttmEW- M0=AY-PWDAY8;00Ay4:9oPN - F][CLU'1JHi W,O'IDu1�. <br /> 1. <br /> L's"'up to ten addresses In the space above. Select the type(a)of files from the list above by checking thx appropr Sats <br /> tra,(ezL At feast one file type MUST bD selected, Fax to(2D0)464-0198-or mail to the addrese Indicated above. At cess <br /> ranges will not be a:eapted-for additional assistance with file addresses,contact the END,Applic:atirns rnelved at',er <br /> 3:CG pm will be proosesed the next business day. <br /> 2 The EHD Will no*the applicant 9 any END tile.:exist An appointment For review will be conHrried apuroximately ten(15) <br /> days atter receipt of appilcatiorl. TITe 17iles wilt be held for a maximum of five business days for Inview. F-.ppnintmenfx <br /> -houi3 Le,i,; €econlinc;ty. <br /> ». q We that is aeuvely;being worked a:1 by END staff may not be immediately available for review. A new application may be <br /> .aubmitted when the ME Is available. <br /> 4. AM'foie not returned In the same condition as misased will be morganivId by END stO at the expense of the Rppiicant <br /> sutura fife m-AeWs hY dee sane appl°;Cant may require a 885.00 deposit prior to review. <br /> END USE ONLY <br /> i <br /> am <br />