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DATE RECEIVED EHD LOG NUMBER <br /> SAN .1OAQUiN COUNTY <br /> ENVIRON <br /> -. MENTAL HEALTH DEPARTMENT <br /> 600 East Main St., Stockton, CA 95202,30 9 Ck <br /> I Telephone: (20.9)468-3470 Fax' (209)464-0138 Web: www.sjgov..org(ehd <br /> PUBLIC RECORDS RELEASE APPLICATION. <br /> APPLICANT: 9 r �(Ct cr�c i oiU, BUSINESSIAt3ENCY: Ce Ac, <br /> ADDRESS: CiTYISTATEZIP: -10 ftw q o zctq q � <br /> PHONE (1): 510 )_LJ_7 9 8b5 PHONE(2) ^O 062.q 'I=ACSIMiLEC l��� <br /> TE/JTATiVE'"APPOINTMENT'DATE: 2 �- 1'irne: S �-��`� <br /> oL p <br /> (Pleaep allow 10 husiness.day,s from date of appUcatlon submitlal-"tentative on -must be confirmad) <br /> ❑ CHECK Box TO EYPEDITE REQ E' 51 5 ._E(GASHO R CHECK bNLYj-REQ ST PROCESr8ED IN 3 9USINE3S.DAYS <br /> SIGNATURE OF APPLICANT DATE (t Z'7 -ZO <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD'USE ONLY <br /> Street# Street Name city Unit 1, <br /> _1 S on RuTa070, <br /> l�aV4� <br /> z. 3 ci p Pa"m ��q <br /> SQL _ —_IJP'-��- O Unit 2. <br /> 3. <br /> Q Untt 3 <br /> 5. - �D <br /> 6. <br /> T. <br /> — - = ---- -------- nit 4 1 <br /> --- _ ❑unit 5 <br /> 9. <br /> O Unit e <br /> Spedflc Date Rai: a of lydormbtion R <br /> equeatad: From to <br /> EtdVIRONMENTAi•'HEALTH DEPARTMENT FiLES ` <br /> ❑ DERGRaUND TANK(UST)CLEANUP SITE(LOP) ElHOU$1W6,AbATEMEHT ❑SOLID WASTE F=L rYNEHiCLE <br /> IrQ OTHER CLEANUP SITE(146N�L-OP) �Fo6o FACILITY Elwgrr TIRE <br /> ❑ 15ROWNO T0K(MarrroR1Nd Ri^i�ova:) 00Q I(EiWIL ❑DAIRY Lv l <br /> [ AzARt 0U$WASTE BENERATOR�< H CHICKEN RANCH ❑WASMWATERTREATMENT PtAHT - 1ElTIEAW PERMUED FACILITY MOTEUH&EL C1P6mPERTRUGK YARD/CHEmAt'T Etsl' <br /> ElTATTWSODY PIERCING. L] SOA [I WO USE APPLIcAmN SRES <br /> ❑ ME=4 WASTE:FACILRY IWCOMPtAW Rt.CORos ❑O7HEH(PLWE;SPECFY) <br /> WELL AND SEPfiC PERMIT'Rtcogo)§ARE AVAILABLE,#d1lt.REVIEW: MONDAY(-FRIDAY$':06AM14 0)PWI( )6LNG,HOLIDAYS) <br /> 1. List un to ten addressees In the space above. Sdiect,the type(s)of flies from.the listabo-ve by chik4dng the.appropriate <br /> box(es).. At least'-one file typeMWTbe selected Fax.tn(2891 9-t1.13t1 'mail Wtheadilaiji Indicated tib , Address <br /> ranges Will not be accepted,-fur additional asslstance with file addresses,contact the'EHD. Applications received after <br /> 3:00 pm wilt be processed the next-business day. <br /> 2. The EHD will.notify the applicant if any EHD isles exist, An appointment for review will be confirmed approximately ten(10) <br /> days after recelpt'of application: The files will be held for a`maidmum of five business days for review. Appointments <br /> should be scheduled.accordingiy. <br /> 3. A file that Is actively being Worked on by EHD staff may not be.immedlately avaliable for review. A new application may be <br /> submitted'when thefiile-is available. <br /> d: Any file not returned in the same condition as-released will be.reorganized by EHD'staff at the expense of the applicant. <br /> Future file reviews by the same applicant may rdquire a$125 depoelf rWor to review. <br /> Nii,G lt5s'.t)IJI:Y. <br />