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Jul 05 06 10:00a Apex 209 ',7-9668 p.2 <br /> h DATE RECEUE() EHD LOO NUN;BEiR <br /> (D� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HF.ALTIT DEPA RTI MNT <br /> 304 Past Weber Avenue, P Floor, Stockton, CA 95202-2703 <br /> Teleplavue: (209) 468-3420 Fax: (209) 464-0138 Web: W1mw.sjgov orglehd V <br /> ENVPOi 011-- jVT ljr , iJpl PUBLIC RECORDS RELEASE APPLICATION <br /> APPLI 't'Q?r� A .A 4••� BUSINESSIAGENCY: # <br /> PHONE (1): ��Z �, 6�'• — (a`� r -5 PHONE (2)1:_LU/�' 6VO — U (a L( �" —FAC56d�Eq���Y - Gn <br /> TENTATNE' APtaownfENTOATE: ���+1 � Tm / h9� � <br /> (Pfease alfaw 10 busing days from date of appueaWn submIttrl - 'TErAhdve only - mlrst ba co>r9mred) <br /> CHEM BOX. TO EIPFA)ITE REQUEST - ;93.00 FEE (CASH OR CHECK ONLY) - REQUES r PROCESSED IN i BUSINESS DAYS <br /> SIGHATURG OF APPLICANT .. DATE ' 3+4 - <br /> rw <br /> �UNITOISTRIBUTION O Urd11 O Unk2 O UMS - O Unft4 D Unk5 D tW..t 5 D Ouler (esedmnicdnsdslmapa) e - <br /> �.�A FILE ADDRESS 13-0 U xE ONLY <br /> SEreet Street Name Gity <br /> 2. 4. lCl N . .I.A a CAR <br /> 6. <br /> 7. <br /> S. <br /> 10. j <br /> Specific pate Flange Of lnformafon Requested: From 'L%tFUZ to &0i %A14 io <br /> ENVIRONMENTAL HEALTH DEPARTMENT FEI-ES <br /> VUNDERGROUNDTANx (UST) CLEANU? SITE (LOP) 13 Hamm AapammsIT 0 ZOOLOWASTEFACILITYMEMNE <br /> 0 OrTHERCL°W SrM (NDm4.OP) O FOOD FACILITY ❑ WASTE TRE <br /> Ci LNaERGROwDTANK[MoNrromNWRFAt0YAL) - O DOG KENNEL D romw <br /> O HATMOOnS WASH GMMATUR D Ewa RANCK Q VYasrtvrATM TIIMV*l Rarer <br /> D TIEREOPEN.R nFAcftm ❑ Pxow . Mom G PVaa'en TRMKrYARD(CH TORsJ <br /> 13 TATIrOOIS001' PURat1O D POOLISPA 13 l ANO USE APPlICAncw SITES <br /> ❑ MEDICAL.Mzm FACIOrY D Onre[t (pervlsESPegPt� . <br /> WFu_ANO SEPTIC PEPowrctISmrmsgREAVA¢Ans : FORREWEw - AtONOAY-FwrtwY 8:00 AhS:WPa[ - Dcp.UoaHe HauDAts._ <br /> 1 . List up to Gan addresses in tate space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es), At Fast one file type MUST be selected.MFax to (209) 4f,q 0138 oa mail to tlee address <br /> indicad al9ove. Address ranges will not be accepted — for additional assBstancewth file addresses, combrct <br /> the EHD. Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EFID will notify the applicant 1f any EHD files e:dsL An appointment for review will be confirmed <br /> apprOXilMately ten (10) days after receipt of application. The files will be bele, for a maxim Ian of five bus mess <br /> delis for revoew. Appollnt%ents should be scheduied acconfingly. <br /> 3. Afile that I,; actively being worked on by EHD staff rimy 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 reorganEed b;f EHD staff at the expense ofr the <br /> applicant Future file reviews by the same applicant may require a MAO deposit prior to review. <br /> awz�as <br /> vrmos <br />