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DATE RECEIVED <br /> ® SAN JOAQUIN'COUNTY SWD LOG NUMBER <br /> r—MIJIRONMENTAL HEALTH DEPARTMENT <br /> co 600 East Main St. Stockton, CA 95202-3029 <br /> S® Q Telephony. (209)46&3420 Fax: ( JVPVr,5jq0v.0rWehd� <br /> L E <br /> o¢ PUBLIC RECORDS RELEASE APPLICATION <br /> sa <br /> APPLIdNT:�Qbb� �aGUo BUSINESSIAGENCY: �.itrC C7l�lt. Gee�c.� ` <br /> Vi�d►t. <br /> ADDRESS: �o w . p g.( . C1TY/STATEIZIP: L.dl.: eA <br /> PHONE(i). PHONE(2): FACSIMILE; 3(0-1 -o3--V4 <br /> TENTATIVE*APPOINTMENT DATE: Time: a ,C11:)(f'Iease atbW 10 huslrtetis days from data of at}ptieatloo eutlNAittat_•Teivo only_WMst b.wed) <br /> Q CHECK BOX TO EXPEDITE RE=QUEST-$125 F SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATA= 4- 1-4 - 1 Z <br /> Efectronfc Information: Ej Rist C]Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> $treat Street Name <br /> City )VO <br /> i t l 1 �.1• '�� w►tiate► . c two <br /> 2. I <br /> ��--- p Untt 2 <br /> 4. <br /> �. XJ unit 4 <br /> 9. - d tE'atl.5 <br /> 0- <br /> speeitic Date Rango of 4tfrxrYrat3on Roqutgte& rmm Unit b <br /> bP <br /> ENtl{RON.MENTAL HEALTH DF-PARTI41EW FILES I� / <br /> (UNDERGROUND TANS((115T)CLEANUP SUE(L{�) ❑ftSING ABATMM <br /> SOUD WASTE FACMN:WI�A1, <br /> E®OTHER CxWUP StrE(NON-LOP) ❑FOW FAmff WAS TmE)UNDER6RW!#DTntc M <br /> HAZAD WASlpS oee pay <br /> Y"ER:O PERIM?7ttFAcurY„,, CWAM RANCH Q WASTEVIAIM TREAMEPL1f, N3�_ <br /> /C <br /> /l UZ <br /> TATTOOWyPWIgCMMOTELMOT£L Q PumPER Tmx-WAn) I ToIMP=JSPA Q LAW usE APPCATM SJTW] tEDAWASTE FACRitY <br /> Car�tatM FUwm [I 0THER PLEM Sty} <br /> 1Wt"4L AND SEPTIC PERMR RECORDS Alm AYAIIAELE FOR REwEw: MONDAY-FIRMY$:00 Am-6,00pm(Excl UDI”HOLIDAYS) <br /> 4 In the apace above. Select the type(s)of file$from the list above by checking the appropriate <br /> boA")- At I®aat orae Ale type MWT be*stetted_ Fax td E20914".01al or assail to ft addnmw kg1kaUd above, Address <br /> range*Will not be accepted-for UW ti mai assistance with file addresses,contact the END. A 4AIcatlone mcelved aftr <br /> 2;00 Pm wlil ba PrO0008041 We next.tnwitrase day. <br /> z The END will notify the aPPllcant If any END filen exist An appointment for review wr71 be confirmed approx{tnateEy tear(to) <br /> days after mcelpt of appl{cadon. The files will be hold for a�of ftve bu6bwas days for review. Appp <br /> should be scheduled accordingly, <br /> 3. A file that E$Actively being wanted on by END staff may not be the immediately&VARabb <br /> submitted whenfor review. A new application may be <br /> file Is available. <br /> 4- Any file not retttrrled In the same condition as released Will be redrgani and by END staff at the expen"of the applicant. <br /> Future fN®reviews by the same applicant may Mquirae a$125 depoait prior to review_ <br /> EMO V6E Of&Y <br /> E►ta�9.qe <br /> EVt <br />