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D—nai i Inc 5",PjH71250 ia. 1 <br /> DATE RECE F-0 ;. EHa LOG NUMBER <br /> " Et,�;� .Il x:� �� I .. - .S�rJOAQM-COUNTYREUI�if�,lJ ENYIRO.wMENTA..L HEALTH DEPARTMENT <br /> 304 EWeber Ave P floor Stockton,CA 95205 <br /> JUL .. <br /> �iW458-3420.Fax: (209)464-0138 Web:www.co.garkj=gv rs.caus/ehd5P <br /> EN'NRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> AMICUT: i ©6.a `4' &W e 1-1 <br /> ADCRESS: 2_z,: 5-Y.'.__ -r?R Pf.�SxN K I k h J�S'2-3 <br /> PF ItiiE:_ ._.�..{�L`2-�' 'i _ FAC;:t if q. 6 P >-- <br /> - - <br /> TEARTATIV! *AP Pp INTPAIT DAVE: y. r� r' o , TirneP f <br /> ?riease aliaw 4A business dl'A rrom dale of APDOCatim xUtmEttal) <br /> CtiacK bOx,rn ExPEDETE:Re1f-Xice T 493AU PEE--FtEQUEST PROCESS4ED IN 3 SIXINEwS DAYS <br /> SIGNATURE OF APPLICANT �'� -'�•'��� � � DATE �- <br /> Depwlamrt Us*Q* <br /> _ PILE AtORMS UNIT <br /> •� 12 -X45 i!rt ft _._ _l n � r/ 0 U cit i <br /> r l i OD- -LY_ l a t_��_ _ — �?�- r,c IYL�- Q Unit 2 1 <br /> ?t vY- _�__.c"�- 'F4t.c. f Unlit 3 <br /> P*4 <br /> a _ U t <br /> ENVIRONMENTAL HMTH DEPARTMENT RLES <br /> 0 ow OF(WND TIVIK{41ST)CLEANUP-SITE(-oP) 13 mou3wo A,,aA rerA N-r 0 SOLIO WASTE FACti.3TY <br /> W OTHER r i EAA+up SITE(WN-Lop�c CI Feau Fmctfry M SCUD WASTE VEHicu: <br /> 01 UNDERCAOUND TANK 0foARY01,WJs avA14 DaG rmWEL M aAfRY <br /> ill 14AZAA.WUS WASTE CZNI 1 A-Dft C {:WK1EV RM,gx}.i L3 Pi(o TREATmmwr PLAmT <br /> ■ TERM PEMn7r-;0 FACIUry, o WTELjVG'T.t. 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> I3 TATf'ixM50DY PIERCING 13 to OLISpA, 0 !.AHD USE APF I CATKM SiTES <br /> 0 MEDICO L WAM FACIE riY l <br /> 1. 1_ist up to top addwt- es f rt&a.spaW a b-mre. Sele-At m types)of fllci�s fmm tine ftt arae by chsc Mrig <br /> the apprapriate boxir.rp). At Wwt one€Ile l)fps MUST bf-selected- Fax to LM 464.01 IS or rre i tf�e <br /> acicamss indicated above. <br /> Z. 'EHO will ratify the aWicuW if any ENDAles edit. An appointment enc resew will be coWlrnwd <br /> a1pr! xlmaltely five husinems dWs but no LsWv than ten('€01 days after receipt of appfw,, lon. The films <br /> wits be held for ea Maxirnuers at five buskwsa days ttx review. Appointments should be scheduled <br /> accordingly. <br /> 3. +'E Me that Is actively Ved on by.EHE)stciff may r-�-,t to krintediatAy availaHe for review. A now <br /> arp?ckfis•an may P.:le.&Fjbrrr4YW when t*filfi: s av iabW. <br /> 4. Any lid not returned in the as rNeasad will be rt'orWi'Ci ied by EHD staff et the expense <br /> cA the aipplicant. Future file revism by the same app lcmt may require a$93.00 deposit prior to review. <br /> 5. *TFzNTA-PVF,appointment dates must he cord1med with EHD staff. <br /> a. ,Anclicatiorse rem4vrwf of m 3130 nm WWI,be wvll r. nfwl 4hi3i namf WnbripffLr.dAv <br />