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Jan 22 2014 2: 58PM HP RSERJET FAX � p. 1 <br /> EMC!LD0 NilMBER <br /> SAN JOAQUIN COUNTY <br /> SAN 2 2 201 ; ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazektan Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL SHEMAPhona: (209)468-342D 'Fax: (209)464-0138 Web:www.ejgay.drglehd <br /> t' <br /> /+ PUBLIC RECORDS RELEASE APPLICATION <br /> C-3 <br /> APPLICANT: 'I'— - ,r BUSINESSIAGENCY: T R C enoilcon <br /> ALiDR-53: al 2rd S4- CITY1STATE1ZIP:&:0 fD_nc_Nc+c <br /> P14ONE(1): PHONE(2): FACSIMILE: ' <br /> TENTAnv&r PPOINTMENT DATE.'j7�L�c-rpt � `Za1�! `Clore: <br /> (please allaw 10 buadness-days rmn date at"I on submittal-`Ten;v1fvw only-must bs ecntimwd) <br /> ❑CHECK BOX TO EXPEDITElREQU EST-$125 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED I N 3 BU� NE55 DAYS <br /> SIGNATURE OF APPLICANT GATE_ <br /> Electronic lnforma#ion: ❑Llst❑Map—Description: <br /> FILE ADDRESS EM U8e ONLY <br /> Strwt Name City �) CjEj,dnft4 <br /> Avt <br /> 2. TAA Y <br /> 3. iZ'4- r <br /> 7. <br /> g, unn s <br /> 0. <br /> ❑Unit 6 <br /> Spo�clifnDate Renee of kdvrmatjon Requested: From to <br /> ENVI;tONMP.NTAL HEALTH DEPARTMENT FILES <br /> g1H4AZARDOLI8 <br /> 33ERGi LfIiO TANK{IiST}t'iE Alit[P$n1r{LOP) []MEl13CAl.WASTE FAdtdTY ❑SoLp WASTIE F 111 lCLE r <br /> OTHER SrrtE(Nol1-LCI?) E]Hous[NOAwr;mENT ❑W"TIRE <br /> f I r' d <br /> QERtEiOIlI TAb]%(tloNrIORII[NitEliloVJIL} ❑F000 FAciLRY ❑b►�[ I 1v 'j[ L( <br /> OVEORWHO TANK ❑CHCXEN KM CHF Doo KEMB.. ❑WA8iMATERTREATMENT PUNT <br /> WAS'TEHAZAMMMATERIALS ❑MaTELIHOTEL ❑ PERTRUFWYAWCWWCALToILET3 <br /> TmREO t7 FACILITY ❑POOIJSPA [ LAND Usr;APPLICATION SiTi:S <br /> TATTOOMODY PIERCNO . ❑CWPtAlIi AMPONSE RECORDS ❑17THE R(PLEME SPECiM <br /> WELL AND SEPTIC PFRm R=Pms ARE AVAILABLE FOR IREVIE w: MOROAY-FRIDAY'8:00 A.M-S:OQplA(EXrLUoiKGHouIDAYs) <br /> 1, Lill up to ton gggresms In the apace above. Select the typo(s)of fibs from the Ilst above byplweciidng the appropslate <br /> box(os): At least one file type MUST be selected. Fox t^(2001464-0139 or mail to the address inrilcatsd above_ Address <br /> ranges will not be accepted for additional assislancowith file addresses,eonta�ct Iles EHD. Applications received after <br /> 3:00 pm will be prorsad the Pwd bueinsax day. <br /> 2. The EHD will notifythe aYppikoant Nany EHD files exist. An appointment for review will be confinvwed approximately ten(10) <br /> days shyer receipt of application. The files will b a hold fcr a ma dmu m of live b sinas:s days for reviaw. Appointments <br /> should be scheduled m=rdinsiy_ <br /> 3. A fl.e that is actively being worked on by EHD staff may not be immediately available for review. A new appllcxtlon may be <br /> submitted when the file is wrailable. <br /> 4. Any file not retur.�`•,"aa...----......a:�--"...r=mei..er11 l+.ranm�y►iawd 1hv�cHD wiafF At fhb earoanaa nil It1�® <br /> Future 11le revIml. '. O'Ci l CJ, GL co ut q--. 7&TJ&^Erf <br /> 14I-, 0'1 f Pr C')-oe J a49P I,, cd,07 ca,f 9 0 <br /> t4aZ/11b.' nrr�l ' rrs " X <br /> ly'• 77 r OF 15 106 <br /> 9a-0 Tre Ie _ <br /> EKD d94N <br /> Received Time Jan. 22, 2014 2:57PM k 5063 <br />