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04/19/2006 19:18 13107982841 PAGE 01 <br /> _... ,. v11 u,4V fb4* ENVIRONMENTALIOLTH PAGE 01 <br /> DATE RECEIVED CHP LOU NUMUhR <br /> SAN,T4AQUIlY COUNTY <br /> R E EV ED 7E=Weber <br /> AvmTAI,HEALTH <br /> Stockton, <br /> rMz - �� � � <br /> 304 East Weber Avenue, 3r°Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: wwwsjgov.orEAhd <br /> APR � 0 [006 <br /> ENIVIRONME PUBLIC RECORDS RELEASE APPLICATION <br /> PE I1TOW LS Q-d�4n SMINESSIAGENar; � <br /> ADPRESS:o 5rx: pCpC7d <br /> �?a air( ( i rATa <br /> PHONE(1q .d^p�".K:?t.J--ice" (2): FACSIMILE���� <br /> TENTATIVE"APPOINTMENT DATE: Tune= <br /> (Please allow 1abusin days Prom data ofappricadonaWmMal-•ranamYeonly-mutt Iwconfimed) <br /> C7 CHECK BOX TO EXPE 3M FEE(CASH OR CHECK ONLY)-MQUEOT FROOM ZD IN 3 SUE' DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electmrdc in114 Lie ❑ 0- OISPUM <br /> IMDrmatlDn —_ - <br /> FILE ADDRESS END USE ONLY <br /> stF.K,t s t e city. _ <br /> 1 E] Unit 1 <br /> z. <br /> 3. D Unit 2 <br /> s. / Unit ;3 <br /> T. Unit 4 <br /> 8 <br /> El Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> qy� - ENVIRONMENTAL HEALTH DEPARTMENT FILLS <br /> rl' UND6RMOUNO TANK(US-T)CLEANUP SMS(LOP) ❑N009IKGAaATMENT X40waWAM FAOILITYfVENKY.6 <br /> ;Y"I!a CLEANUP$FIE(NON-LOP) ❑FOM FACR1rr d WAm Teta <br /> UNMRGRWND TANK(MONFTOMgftMOVM,) ❑DOG KFNW!L ❑bAIRY <br /> 0HAZAR90U8 WAMt Gr%EPATDR 0C""M RANcN %Q WA81EWAM TRe�TmIrr PLAtrf <br /> 13 Tmnm Faiv4r rm rAcmm ❑MOT0LMOTEL ❑PowsR TRucKYAFm1C=K;4 To%c - <br /> 13 TATTOOIBODY PIERaita ❑PObLFSPA ❑LAND UZO APPLICATION StM <br /> ❑F&MAL.WASTE FAMUTY r]OTHER(PLEA36 SPECtPY) <br /> WELL ANO SEFMC.PERan R=M03 ARE AVAMPL6 FDR Rrd Ew -MONDAY.FRIDAY 0:00 AM-5:0" - EXCLU13w,HOIAAYYS. <br /> 9. List up to tan addresses in the space above. Select the type($) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected- Fax tD(209)464-0138 or mail to file address <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addreslscs,contact <br /> the EHD-Applications received after 3:00 pm will be p=essed the next business day. <br /> 2. The EHD will notify the applicant if any EHD film 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 /> Z. A file that is actively being worked on by EHD staff may not W immediately available for review. A new <br /> application may be submitted when the file is oyaiiable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD etaf'at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.OD deposit prior tc review.649 aB.W <br /> fea11]tl06 <br />