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logZntj� lb:'Ly 2096342883 FEDEXKINKOS PAGE 02/02 <br /> DATE RECEMD � �� END LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 3 ONMENTAL HEAD Dr-PARTMENT <br /> 04 Ewt Webew Avenue,P Floor,Stocktm,CA,95202-2708 7 <br /> 5 2005 Tett Worn (209)468-3420 Fax:(209)464-0138 Web:www.:ggov.org/chd <br /> Eh LNjjjEAIIH PUBLIC RECORDS RELEASE APPLICATION <br /> `} BUStN655lAOH4CY: IX L.NV i Ja� <br /> ADDRESS', G4 -ZS73�8Z <br /> PHONE4 Lia <br /> ( ):�__. 7'�-�- I�o��'{ PHONE(2): Z�' � Gkit ^ ���1 -FACSHAfLE. <br /> TENTATIVE"APPovmwE w-t DATE <br /> Mew m allow 1a btmlras days tram die of spode ian mkn*tal-*rm adfre only-must be="fi nnEed) <br /> ❑ CHECK SOX TD EXPEDITE REQUEST-"100 ME(CASH OR CHECK ONLY)-REQMT eWXSSED IN 3 SU NESS DAYS <br /> SIGNATURE OF APPLICANT _ �1�li-�V DATE _ Z.�t to <br /> UNfT DISTRfREfrTON Q ur:t t D Unit 2 0 Unk 3 Q VoR t 0 Ura 6 0 unit ti 0 O#w(etectmnidlW hr ) <br /> FILE ADDRESS END USE ONLY <br /> Street N street Name City, <br /> 4. V 1�I', <br /> 5. <br /> 7. 9 <br /> 10. Vy 7, <br /> Specitlo Date Range of Intor>t atkm Raquutad:From - _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ;4b- EROROUND TANK(UST)CLEANUP SITE(t.AP) Q Hausm ASATE mw ❑SOM WASTE FACa.rryAfE IacL4 <br /> 13 OTM CLEANUP SITE:(NON-LOP) ❑F000 FACwmr 0 WASTE TIRE <br /> 0 UNDEROROWMTANK(MOWOMNO1ReEOVAL) 0 DOG KEEL ❑DAIRY <br /> 0 HAZARMUS WASTE QDiERATOft E3 CEac"RAP6W 0 WASTZNtATM TRFATVWT PANT <br /> O TIERPA Pf RMITTEA FACErrY ❑NOTUL At0TE L o PUMPM TkUCIdYARdCItEN Toe.erS <br /> 13TAir )ooy p FPa3R m n Um 0 LANjD uAPPI.Icmm srrfs <br /> OnICR(PLEAM SPOWY) <br /> WELL AND SWM PE RIM ReWRo4 ARE AvAtt M E FOR Revrm-MONDAY-FMAY 8:00 AM-5:00PM - EXCLUM0 HOLIDAY. <br /> 1- List up to ten addresses in the space above. Select the type(S)Of files from the list above by Checking the <br /> appraprlat%boX(es). At!asst one file type MUST be selected. Fax to(2091484-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addressee,contact <br /> the EHD,Appllcatians received after 3.00 pm will be prooessed the next business day. <br /> 2. The EHD will nOft the applicant if any END files exist. ,An appointment fo+rcwvisw will be 000firmed <br /> aPPr0xlnta*ten(10)days anw mmapt of appuc,t . The files will be held for s maximum of live business <br /> days for rftVW r. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHL)Staff may not be immediataNy avWlable far review. A nevE► <br /> aPPl�on may be Submitted when the file is avallabie. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of file <br /> applicant FuWre file reviews by the same applicant may require a$93.00 deposit prior to inview, <br /> i <br /> �tD.s-02ooe I <br /> IMAM <br /> i <br />