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Jul 05 06 10:00a Apex 2097-9663 p2 <br /> • I--am LGG NUNRG4 <br /> DATE RECEIVED SAN JOAQum COUNTY <br /> ID EIVVJRONW,NTALHyALTHDEPARTri4ENT <br /> 304 Gast Weber Avenue,3"'Floor,Stockton, CA 95202-2703 <br /> JUL 0 J 2bu) Teleplaone:(209)468-3420 Fant (209)464-0138 Web: Www.sj90v.0T Jehd2 <br /> ENViROPJ�IENT HEhu ITUBLIC RECORDS RELEASE APPLICATION <br /> J BUSINESSIAGENCY:_„-i .------ <br /> APPt.1 r:� <br /> ADDRESS,3z v" <br /> Y (��►�.-. h�r-a PHONE( : <br /> PHONE(1): f <br /> TENTATNEA APPOINTMENT DATE: :r- <br /> X41 —r - <br /> (piease allay SO businaa3 days from date of appllCaMn SO Ittal-'Tentative only.mast be cwn9rtned) <br /> ❑ cHEmBOXTo EXPEDITE REQUE93.O6 FEE ICASH OR CHECK ONLY)-REQUMT PROCESSED IN BUSINESSDPifS <br /> SIGNATURE OF APPLICANT U A.U, %�/V\ DATE s 06c. <br /> UNIT OISTftIBUTtON ❑UnU 1 ❑Unit 2 ❑Unit 3- EI Unit ❑Unit 6 Q Wt 6 Q MOT(elec'bvn��U�'t�^F's) <br /> — FILE ADDRESS EHD USE ONLY <br /> Street PF Street Name CRY <br /> 7. kf Ga '8s rz. Mtn;^ 4a <br /> �.tc. µ. ..., CACA2. <br /> 3. 1\\� <br /> 4. <br /> 3 _ <br /> 6. <br /> 7. <br /> 9. <br /> Specific Date Range of Infomtafion Requested:From T ND*k to <br /> EfMRONMENTAL HEALTH DEPARTMENT RLES <br /> ❑HouSMAeATEMHR ❑SOUD WASTE FAOUTYMEFMME <br /> CCrrHGRCU-_0UTArr (N0NSTJ L1.EANu?SrtE(LOP) El FOOD FACa.rTY ❑WASTETIRE <br /> ❑CTTHER CLFJl411aP SrfE(NON-LOP) ❑Dos;KENEB O DAIRY <br /> ❑L3aERGROUND TANK(MoWoMNGIRE110YAT.) 13 Cl�RnNC>e QVVasTswATEx RT-O1TT�BlT RtWr <br /> HArARDotA w/vSiE GENEPATOR ❑MOTEUHOT O Pe R TRUC VJYAR0 CWf M_r 1- i5 <br /> 0 TIERED PER1(nT£D FACA C POOUBPA O LAND USE APMACATKM'SITES. <br /> ❑TATaoo/B001'PO MNG D OTHER(PtPASESPeraP� <br /> ❑MEDICAL WASTE FACILITY <br /> WGu-AND SEPTIC PEFWT RECORDS ARE AYAnjd EPOR RE1nEW- MONDAY-FRimy 8:00 An•S:00PU— EX LOWK)HOUDA13._ <br /> 1 Int up to tan addresses In the space above. Select the types)of files from the list abIwS!by checking tie <br /> appropriate bor(es). At least one file type MUST be selected. Fax to 20914ti4-0138 or mail to the address <br /> indlcabA above. Address ranges will not be accepted–for additional assistance WEE file addresses,cotaba <br /> the EHD.Applications received after 3:00 pm Will be processed the next business day. <br /> 2. The EHD w ll notify the applicant if any EHO fifes exist An appointment for review will be confirmed <br /> ap?raxiimately ten(10)days after receipt of application. The files will be held for a maxim Tan of five lausines; <br /> days for revuew. AppoUttarellts Should be scheduled accordingly. <br /> 3. Afile that is;actively being worked on by EHD staff may not be immedi tety amatiable for review. A new <br /> application may be submilted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganised by EHD staff aC the expense of tla3 <br /> applicant Future file reviews by the same applicant Wray require a$93.00 deposit Prior to reviev r.�` _ <br /> "'VN'-02-0e6 <br /> 1fINR <br />