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DATE RECEIVED SAN EHD LAG NUMBER <br /> RC V � � � ENVIRt7frIMENTAL RUIN COUNTY <br /> t }`" � �►LTW DEPARTMENT <br /> 000 East Ma( n Vit:�$tockton,CA-95202,X2- 9 Ck <br /> } � I Telephone: (20,9')468-3420'Fax! (20.9)464=0138 Wsb;wvjriv:sjgtiv:.orgNehd <br /> PUBLIC RECORDS RELEASE APPLICATION. <br /> APPLIC-ANT:-Di r siC P rhc 1 ot- 5 RUMNESSIAGENCY-EEASFnVi(�y1i <br /> ADDRESS: - CITY/STATEJLIP - 7PMty(q(?-o C g45,q) <br /> PHONE (9): S10 )-L}-7 8y5 'PHUNE(2) 0 `--�. OGZq '>:ACSIMIL.ECS10-) (-s--,-flg <br /> TENTATIVE*APPOINTMENT DATE: 'Z Time <br /> z. ( r-, � 2 O F:nA <br /> (Please alloµr 10 business,days from d,ete of application submltfal-"Tenfative an y must be coMrrmed) <br /> ❑ CHECK BOX TO EXPEDITE_REQ .E125 FEE(GASH OR CHECK ONLY) . <br /> •REQ , ST PROCESSED'IN 3 9USIN.ESS DAYS <br /> SIGNATURE OF APPLICANT DATE I Z-7 -W Z <br /> Electronic information; ❑ List 0 Map-Description: <br /> FILE ADDRM EHDAJ§E ONLY <br /> Street 0 Street Naiine City _ lMit 1_ <br /> ----�_ <br /> 1. 00 N-ro IRA7A <br /> ^2 3 y o O c ,za I j` <br /> �o rJ P -�___ -T � �.> -- -- ..o Unit 2. <br /> 3. —�LA ZP - <br /> -- C14---- -....._- .. <br /> — -- ----•.__---- P Uritt 4 i <br /> T. --- <br /> 8. T --- - <br /> --- — ❑unit 6 <br /> 0 unit e: <br /> Spociflc Date Rarige 01rdorhtation Requested: Fromto <br /> ENVIE:kMENTA['HEALTH DEPARTMENT FILES <br /> V❑ DERGROUND TANK(1ST)CLEANUP SITE(LOP) El Housika ABATF-mw ❑SOLID WASTE FACILTTY/VEHICLE <br /> OTHER Gl EANUp SfTE(N6wLOP) FOOD FACIiaTY HDAIRY <br /> WASTE TIRE <br /> M00M. TANX(MONtt0RuiblRtMoVAL) I I'RAIiL I <br /> AW00011WASTEGEP G.Hi klfNERATOROQ NRANCH ❑WAWEWATERTREATMENTRANT -I-) <br /> 11TIENW..PkMITTIm',FAaiTY WTEIAI&EL ❑PupPER�TRua&,*RaMw1dcAL'T6dbs <br /> [ITgT7.polBopY PIt arquG. []f 8>;A ❑LA UaE AaPLicaTtoaSrres <br /> El MEgICAL WASTE FA1mrTY OOKAW REdoltoe. ❑OfOM(PLEASESPECFY) <br /> 1NELL AND SEPTIC PERMIT REcogi Afm AVAILABLE#dFt.RCVIEW: MbNDAIf-'FRIOAY 8`00./1-4, 660M(E)(6LijDIN6-HodoAys) <br /> 1. List ua fa ten address In the space`abolre. <br /> Select the types)of files from the list aboVe by chb*fig the" Appropriate <br /> box(es).. At leastone file type'MUSTbe selected. Fax.to t201464�11138 oe'mail i0460iddre l00gated a_boV .. Address <br /> ranges Will not be accepted-for additional assistance with file addresses,contact the'EHID. Applications.received after <br /> 3:60 pm.wail be processed the next-business day. <br /> 2. The EHD wI111notlfy the applicant if any EHfa:iiles exist, An appointment for review will be ctonill ed approximately ten(10) <br /> days after recalpt"of application'. The files will behold for a'7naxlmuth of five business days for review. Appointments <br /> should be scheduled.accordingly; <br /> 3. Aflsubmitted <br /> e hat Is icti'vely being worked on by EMD staff may not be.irnmedlateiy avallable for review. A new application may be <br /> when the Wells avallable. <br /> d: Any file not returned In the same condition as,released will be reorganized by EHD'staff at the expense of the applicant. <br /> Future filo reviews by the same appiican#may regtiii$a$125 depoOlt'prlgr to.r+avl." <br /> Faiu�tSF nw:,•. <br /> D 4.8-0 811/1 <br />