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JeU• L. LUUO IU. I IAM N0. 2539 F. 1/2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Last Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or leh <br /> PUBLIC RECORDS RELEASE APPLICATIQN <br /> APPLICANT: Mn /o, BUSINESS/AGENCY: S r J<n <br /> ADDRESS: IV inti I7V CitylstatelZlp <br /> PHONE(1): Z S 35k`1�9� 0 3 PHONE(2): FACSIMILE: . 3 <br /> TENTATIVE`APPOINTMENT DATE:- • Z� 2O�S Time: et V'1 <br /> (Please allow 10 business days from datof applicatlon submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$I,qg Fff(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic Informat <br /> Street 0 <br /> M USE ONLY <br /> 1. - -- - - -. , ❑ Unit <br /> 2- Z17 _ - -- -_ ❑ Unit <br /> 3. <br /> 4. - - -- <br /> � nit 3 <br /> ?06 ///''��� Unit 4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. p <br /> d3 --�.__T� -- ---- --- ❑ Unit 6 <br /> Specific Date Range of— _— - - ----- - -- - --- <br /> UNDERGROUND TANK(US 'ACILIYYNEHICLE <br /> OTHER CLEANUP SITE(N( <br /> NDERGROVND TANK MC--- -" "- --- <br /> -- --- <br /> AZARDOUS WASTE GENE FREATMENTPLANT <br /> TIERED PERMITTED FACILI ..-__-- _...-. JYARD/CHEM TOILETS <br /> TATToo/SoDY PIERCING -- - - — --- - JCATION SITES <br /> 0 MEDICAL WASTE FACILITY <br /> ---- <br /> LL AND SEF- -- ------------------ AUDING HOLIDAYS, <br /> 1. List up to ten addras _____ ____- mking the appropriate <br /> box(es). At feast ons------------------ —--- - - - <br /> �dicated above. Address <br /> ranges will not be ac plications received after <br /> 3:00 pm will be proc _----------- <br /> 2, The EHD will notify t ned approximately ten(10) <br /> days after receipt of -----eVlew. Appointments <br /> should be schedulec----- <br /> 3. A file that Is actively _-._- A new application may be <br /> submitted when the--- <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant, <br /> Futurefile reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />