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07/12/2006 10:55 209-579-2 MODE5TO ATC PAGE 02 <br /> cm4a Et�v^En�D <br /> SAN SOAQUCltNi� �DECENVIRONMENTAL Hrt octet-ror eR <br /> HEALT)4 UEPARTNiLN'T �� <br /> JUL 1 2 200fi 304 Fest Weber Avenue, 3'1 Floor, Stockton,CA 95202-2708 Z?e <br /> I'etephome: (209)468-3420 Rax:(209)464-0138 Web. wvvw.sjgov.org%ehd <br /> ENVIRONMENT HEALTH PIJBLTC RECORDS RELEASE ICATION <br /> pEmfallT � <br /> APaaaDANr;L� ' ffi _______�. <br /> r, <br /> AWRESS: £����. ni�pp����jtrrF.�-,�F's.L.i__'n XmCL {1'kiL'?E"�-cy c'�+. __�7_r) _ <br /> PHONE(1):�.�__..a.y:�xatdsl_. PHONE(2): FACSNALE^-����y,a�.�. '21* — <br /> TCt4TAnVL-APPOMMIENT DATE:_ 7.211.06 Tama: EAS{ , <br /> (Please affow 10 taaetnaas days from date of aWicstlDn seboo"-`Tetdad"*Wy.must be eorAn gad; <br /> C7 CHECK sox To expeorre R J T.593.00 FEE(CASH OR CHECK ONLY)-REZIEST PROCESSED IN.1 OUSINES9 tWni <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT tN8tRtEtil3Kh*7 ❑Unit 4 d Unit 2 d Unat 9 d tbn3!k ❑Unit 8 0 (Intl f O OuNr(saegrenarf,IstsfiiRps) <br /> FILE ADDRESS END USE ONLY <br /> �.— -._._. <br /> � <br /> _ <br /> ----r <br /> 2 i-- <br /> .. _ 7:k�P ..---. .. _ _ _ ... <br /> 4 _ ? % .- . 0 <br /> - ---- - _ <br /> 7. <br /> 3 <br /> ___. SPMEre4absR0n9aofN3f mtaiaor€Ragtassitut;_From. FAST to CAI?L"` <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> kOERGRIX.vW TEAK(UST)CLLWP$nE('-_tom') dHOU04 ASAT04W Z SOLO WASTE PAgk TYC✓Enk1U <br /> �P�oTN6a CI.thRUP SITE(IioRZOP) d FOOD FAM"Y 0 wAsTE TME <br /> Pw'c�R• vmRCIm Tow(6tO,YaTORflVG7REaOYA.) ODOG KemWL 0DARY <br /> ','A'Th'.A2 mous WRITE OEKERATUR a CWKM RAI CH d WAsmvATERTRFATllm PLAW <br /> d TEFREO PEP19rED FAVLM 0MotwffloTA 0 PoasR TRUc+01'ArWCmEN To&rrs <br /> 0 TAT'r0015(XNP1M1 4G d POOLISPA 0 L"m UsE APftxATKNi Sms <br /> 7 t1aE:MAL WASTA 1-A LLVY D OTHER(Pa"t Speasy)__ <br /> WELL AND$FFM FEPxff REtORm ARE A#AP.AELE POR Rffy%W• MomAy4tmoAy 0:00 AMS:00PM - EtCIE toe Ho 'HOLtOAYa._",tlr^Y� <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking t ve <br /> appropriate box(es). At least one file type MUST be selected. fax to(203)4!—"11 or,mail to the add <br /> lndjkated REx+ve, Address ranges will not be accepted-for additional assistance with file addresses,contoca. <br /> the EHD.Applications received after 3.00 pm will be pracassad the next business day. <br /> 2. The END will notify the applicant If any END flies exist An appointment for review will be coafirmed <br /> approximately ten(19)days after receipt of application. The f las will be bald for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A Me that Is actively being worked on by END staff may not be Immediately avallable for review. A now <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 expense of the <br /> applicaast. Future file reviews by the same applicant may require a$93.00 deposit prier to review, <br /> �1 <br /> . i <br /> kiF'e5 <br />