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2094626171 STOCKTON PETROLEUM C PAGE 01 <br /> EHO LOG NUMPF <br /> SAN JOA U <br /> Q zN COUNTY <br /> � <br /> SUP=2W ENVIRONMENTA.L HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`a Floor Stockton,CA 95205 <br /> ENVIFtGNMENTAL �14-3420 Fax: (209) 464-0138 Web:www.co.san-joaquin..ca_us/eha <br /> F�EfliS11IT'1:��Vt <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 / BUSINESS/AGENCY:----------- <br /> ADDRESS: ✓rJ /� �Jr J/yr7`;1 �i4Sal _.. <br /> PHONE: 67c; r <j t c -'j S 5 FACSIMILE: V ci' 2 _ <br /> T. <br /> (/�7 � <br /> TtNTATIV *APPOINTMENT <br /> tJDATE' /C; /.�"r,7 Time- <br /> (Please allow 10 buatness days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE F?EQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /�./ DATE <br /> �� <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> ! t. Street <br /> i 5 ., .__ p a 7�'�. 91'�o/ V m ./Unit 1 <br /> :> Street y _ �• G > o <br /> l •1 -/ �- 2 1.?� Unit 2 <br /> 7 <. Street 20-7 _ GI V <br /> Street �� Unit 3 GI f <br /> 1�f __..._—__ <br /> city <br /> r. street G Unit 4 <br /> e. suvet City <br /> 9, Strcet _. _._`...� City Unit 5 <br /> 10, Street city- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONfrORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 11 PUMPER TRUCKlYARD/CHEM TOILETS <br /> �) TATTOO/BODY PIERCING ❑ POOUSPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) _.. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checkinc <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated ab9ve. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt bf application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly.. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately.available for review. A net <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by END staff at the experts <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie, <br /> 5. *TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE" <br /> _V1540-02-006 - - <br /> 8=003 <br />