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` "" •1 2094626171 STOCKTON PETROLEUM C PAGE 01 <br /> � �'�'�• ENI LOG NUMnf <br /> SAN.JOA UIN COUNTY <br /> Q <br /> SEFP MZW ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d door Stockton, CA 95205 <br /> E�1 PER <br /> Y.SER N1�_3420 Fax: (209) 464-01.38 Web: www.co.san-joaquin.ca.us/ehe <br /> RE�iXAtT'%:�EA�I <br /> I <br /> PUBLIC RECONS RELEASE APPLICATION <br /> APPLICANT: V� — /:P Z BUSINESS/AGENCY: <br /> ADDRESS: ^_�/rJ iTZ <br /> PHONE: c2 0 '' 6 �a j r,� s-- FACSIMILE: 1-2 0 51 Z - <br /> (�� f7 U <br /> I ^T�N TATIVE'APPOINTMENT DATE: Tlme: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS C <br /> SIGNATURE OF APPLICANT _/ DATE X1'7 <br /> Department Use Only <br /> FILL=ADDRESS UNIT <br /> Street P Clr �f c y r�o% Vy�t <br /> .5�._...d�.__ �Unit 1 <br /> •1 .1 J. 5lreei n -Sl-- -T .. /`, - G` � �' J ^ < U Unit 2 <br /> ., <br /> a 51ree12 y T <br /> 1 �'> 1, 5 S eet - - - Crj Unit 3 "Vr7 <br /> 6. eel <br /> Uy O-X . <br /> Y. $Iraet G1 Unit 4 <br /> 0. Street City <br /> WOW <br /> 9. Street _- _ Cir ❑ Unit 5 <br /> In. 51rge1 CI _, <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> "UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> IZI TATTOO113ODY PIERCING M POOUSPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checkinc <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt bf application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A ne, <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by END staff at the expens <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revia, <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD I0-02-006 <br /> aeaoo� <br />