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yep. L. LUUb IU; I IAM No, 2539 P. 1/2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Fast Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgay.or eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: J Nene/ h 5`14jqy/ BUSINESS/AGENCY: ✓ r /On <br /> ADDRESS: /✓� l� 17C� City/StatelZip n �" q <br /> PHONE(1). 25 3�� � 0 3 PHONE(2): FACSIMILE: JcS <br /> TENTATIVE`APPOINTMENT DATE:- �7) 24yg Time: a *1 <br /> (Please allow 10 business days from dat Zc of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-,$,�1 SS,,F�ff(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /hfis�/i�l7fi�.rif—J l D <br /> Electronic Informat <br /> 4D USE ONLY <br /> Street 0 <br /> ❑ Unit 1 <br /> 2. Z17 — ❑ Unit 2 <br /> 3. 10 <br /> 4. 665 - - <br /> -- — Unit 3 <br /> Unit 4 <br /> 6. <br /> unit 5 <br /> --- -/ _ - -- ❑ Unit 6 <br /> 10. D3 _ - <br /> Specific Date Range of <br /> t <br /> NDERGROUND TANK(US ACILITYNEFiICLE <br /> OTHER CLEANUP SITE(N( 5 <br /> NDERGROUND TANK(MG----- - - <br /> AZARDOUS WASTE GENE FREATM ENT PLANT <br /> TIERED PERMITTED FACILI - --- —IYARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING JCATION SITES <br /> 13 MEDICAL WASTE FACILITY <br /> WELL AND SEF- -- - -.- - -_ XUDING HOLIDAYS. <br /> 1. List up to ten addre: _)eking the appropriate <br /> box(es). At least on______ __..-_-- --_---.- - - dicated above. Address <br /> ranges will not be ac plications received after <br /> 3:00 pm will be proc -- - <br /> 2, The EHD will notify t ned approximately ten(10) <br /> days after receipt of --eview. Appointments <br /> should be scheduler-- — <br /> 3. A file that Is actively _ - ___— A new application may be <br /> submitted when <br /> 4. 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 require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 8/04/08 ._ PUBLIC RECORDS RELEASE APP FORM <br />