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From:MARCUS H. BOLE AND 16CIATES 530+633+0119 1/2007 16:40 #404 P.001 <br /> ,t048/2e05 110 �7 <br /> , 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> SMJOAQUINCOUNTx <br /> ENMONMENTAL HEALTH DEPARTMENT <br /> AP ' 3 2007 304 Pat Weber Avenue,3rd Floor, Stockton,CA 95202-2708 55O <br /> n. cv t Y it, i_ gelvhooe:(?A9)46&3420 Flax:(209)464.0138 Web:wwwsjgov.orgleh <br /> PUBLIC BECOR� S RELEASE APPLICATION <br /> APPLIOANT:1l/ zc4giAr vi:i /O <br /> 9USINFSSrAOENCY: �. . <br /> ADDREss: .E D. /lXa <br /> PHONE tt -/a' - PHONE(2k 9/.Ci -7//2:212M/ ' FAC&MILE:_j-Co- <br /> MTATIVE'APPOINTMENT DATE V//7 'rime: V � <br /> (Pksse allow T4 buslncs days lromd or sppuca0an sutxnNtal-•TmfaLre only-mush . <br /> \ XCHECX BOX TO EXPEDITE REQUEST-=93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN a BUSINESS DAYS <br /> -SIGNATURE OF APPLICANT DATE y „ o <br /> uNMMsTPMuno T 0 Unit 1 0 ut*2 Uidta d Unit 4 0 Unit S O UrAe 0 ouW(eket*M0istslmap4) <br /> FILE ADDRESS <br /> �Oj streeeea aaceeNanro EHD USE ONLY <br /> 1• O Mzo�. ,U E,=" <br /> AY0 Al <br /> 3. a L <br /> (� 6. <br /> 7. re <br /> 1 D. <br /> 'Specific Data Ral,go OfInformation Requeslad:Fran AIM to oda' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d�In09tG WOTANK(ry=�T)CLEAMV.S:rE"P) 13H%MN3 MAtMWT O Sq.IbWA=FAc Lm0Yt=LE j <br /> ,9THm CLEA"SM(Norm OFmo FA*XM OWAM TRE <br /> UNDERGROM TAM(MMeTQNNQ %EMAL) 0 Doc KENNM O WmY <br /> O KCAADOOSWAM 000ATOR E7 RANCH 171 WASTE ATFATREAT%tawPLANT <br /> 0 TIERED PEPARTO FA=Y a�Tq 13 PmPotTwV NA=10w 70Lrm . <br /> O TATtoa9oorPencm 0PDet1SM - 0 IAND Use ARM=MN SM <br /> O MCDI AL WASTE FAC LrrY O OnzR(Ft•FAbE SPEc� <br /> wH.L AND Sync PERWT REcaaDS ARE AVAAAJ FON PjeAeY- MonAT-rmAY Moo AaSc00ra - Fka.t NorzoAm i <br /> 1. List up to ten addresses In the space above. Select the.types)of files from the list above by checking the <br /> appropriate box(os). At least one file type MUST be selected. Pax to fz091 A64-0138 or mail to the address <br /> )ndiated above. Address ranges will not be accepted-for additional assistance with til-addresses,contact <br /> the EHD.Applications received atter 3:00 pm will be processed the next business day.' <br /> 2. The EHD will notify the applicant N any EHD files exist An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorgantzed by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit.prior to review. . <br /> i <br /> t: <br /> EHa uAxaos <br /> rsRxA <br /> j` <br /> 1 <br />