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05/20/2005 10:00 4640 ENVIRONMENTAL HE a PAGE 01 <br /> � iI W�CJ SAN JOAQUIN COUNTS cn�L��V�,� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Mi AY 2 0 2005 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 :�u <br /> Telephone:(209)468-3420 Fax:(209)464-013$Web:www. gov.org/chd <br /> EWIRONMENT HEALTH <br /> RERM1T/SEI3VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r'4 Lear- 5U31Nr6slAGENCY: <br /> ADDR!!66: t'i I a -j �rIO)C i ¢t Q� Ito rkirl" C s� 9 <br /> PHONY(i) 't� ( 3 ' IT- PHONE(2): ~ I ---FACSIMILE: 1 L Z S <br /> TEN'T'ATIVE"APPoNrmFNT DATE <br /> (pl.nr■now 10 booms days from dab of application cubmlttAl-'Tvnradvq only-muot ba oonflniwd) <br /> 13 CHPCK DOX TO WEDfT6 RRQU T-$93. (CASH CK ONLY)•REQUEST PROCESSLD IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'DATE <br /> UNIT a18TR1BUTION Q Unit i O Unit 2 Unit 4 0 Unit 5 ❑ Unite 110tMr(&f*etronlclllatn M") <br /> FILE ADDRESS EHD USE ONLY J / <br /> Street R street Name City <br /> r.4 <br /> 8. <br /> G. <br /> 7. <br /> 8. <br /> 4. <br /> 10. <br /> SpecMe Date Ranee of InforrnaUon ReQuQeted:From <br /> to - <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> »Howw:AIATEMMT ❑geLio wACTr FAcu m NBF4cu <br /> BROUNe TANK(UST)CLEANUP EITS(40P) 0 FoW PACiLIT'f 0 wAtTG T�� <br /> :RTMUR CtPJNt11 gall(NONa.QP) ❑Doc Kwmw- ❑DARY <br /> u" ORouNn TAW(MONTORI At) 0 CHIm"W PARCH 0 wArTIWATIR 1*2ATML'NT PLANT <br /> f� „L1 <br /> d y pay W W GEWLIA00R MoHerrL <br /> 0 PUMKR TAU=YA1WfCW"TaLm <br /> ❑TImw phAmrrm PAcLrrY ❑POOUSPA ❑LAND USP_A"LICATION SrMM <br /> C]TATT60m=Y Pi vma ❑OTHER(PLuaa 8"Cry) <br /> D F&MCAL WAVG FACILnY <br /> WELL AND$sPYtC Pl!RW RAWRO4 ARE AVAILAAC FOR PAVI w• Mw+Onr�1ttpAY 1:00 AM-S:OOFM - E7�cW LINO t <br /> of files from the list above by choeking the <br /> 1. List up to ten sddresses in the space above. Select the type(s) 3a v address, <br /> appropriate b0x(61* At I0"t one file type MUST b■aaleotvd• F <br /> es ranges will noto accep <br /> indicated abov Addrobted--for additional a9sleWnce with fllo addref�saa,contact <br /> the EliD.Applications received after 3:0o pm will be;t An appacd ntment f6r review will be confirmed <br /> Z. Tito EHD will notify the applicant If any EHD pp[Iiles exist. An appointment <br /> npproxf matoTy ton (10)days gttr'r receipt a!application. The filen will be held for a maximum of five busine� <br /> days for revlow. Appointments should be scheduled accortlln9ty, <br /> 3, A file tis actively being vrorW on by EHD staff may not be Immediately available far review. A new <br /> hat <br /> application may he submitte�`whvn the file is available. <br /> �4. Any fila not return�In th�mv condItIon at <br /> dI v pplicant may lfiagOd II be regia 383�Q ddvpvtitry �prior er revles„at the pense of the <br /> applicant" Future file by <br /> Irl�C <br /> 0/10 'd Z0 199Lb6H 'ON XVA ]VNO I 1VM]1N I SNS I 1100 Wb 10:60 I Nd SOH-H-AW W <br />