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APr . 1 / . zuub 3: IIPM N 1123 P . 1 I <br /> DATF RECEIVED <br /> � SAN J OAQUIN COUNTY "W EHD LOG NUMEIE R <br /> ENVMONMENTAL RE4LTH DEPARTMENT <br /> 304 East Weber Avenue,3'j Floor; Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-013$Web: www sj-ov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: N BUSiN)wSSIAGENCY:�SP � S Sic I �� <br /> ADDRESS. a/ Sr L�1 N CITY t srATE C�— <br /> PtIONE PHONE(2); r-ACSWLE; G�b� 5 6 2 <br /> TENTATIVE;*APPOINTMEKT DATE "-..Su <br /> 0 c Tune:(Please allow10 buSinaSS days from data of appllbmittal•'Tentative only-mus:be conf r.Tnad) <br /> Q CHECK SOX TO PJCPEDITE RE ST.$93.00 E(GASH OR CHECK ONLY)-REOVEZT PROCESSED IN-"BUSINESS EjkrS <br /> SIGNATURE OF APPLICANT DATE — <br /> Elect mnia M List to Map-Descripdon — <br /> Informabon <br /> FILE ADDRESS EHD USE ONLY <br /> T �tkvat# stract Name City <br /> I <br /> 1. ❑ Unlit 1 <br /> 2. o <br /> 3, Unit 2 <br /> 5: ❑ Unit 3 L / <br /> �. o <br /> ❑ .Unit 4 <br /> 7 <br /> s. ❑ Unit 5 <br /> s. <br /> 10: ❑ Urla <br /> spec Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERfi"UND TANK(UST)CLEANUP$M(LOP) ❑HOUSINZ A13ATE47I=4T M SCUD WASTE FACLT N6HML£ <br /> 13 OTHER QXANxm Sat(NOK4_0P) til FooC FACLLM WAM TIRF <br /> ❑UNDER41ROt1NoTANK(MOKr1'aR e/P.5M0VAL) 0 Doc K9KNn 0-my <4 —� . <br /> = HAztyr=US WASTE GUQUATOR C3 CHICK!N RANCH C1 WEW <br /> ASTATER TREATMENT PLANT <br /> C1 TPERED PuPAIrrED FAC41YY M MOTELMOTEL M PUMPaRTRUautYARDlCFEMUALToILZrs <br /> ❑TATTOOIEZODY PMRCFNO. Ca P09t1SFA Cil LANo USE APPLIcAYIPN SrrES <br /> •WbICAL WASTE FACIUTY C OTHER(PLEASE SPECIFY) <br /> WELL'AND SI:P-nn PERMIT RECORD$An AVAAABLL Poft REVIEW-MONDAY-FRIDAY 8:00 Ain-&:OOPIZ - EYCLUPW.0 HOLIDAYS; <br /> t. List up to ten addresses In.the spage above. Select the type(s)of files from the list above by checking talc <br /> appropriate box(es). At least one file type.MUST be selected. Fax to(209)464-0138 or mall to the addre,-:.�; <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact <br /> the EHD.Appllcatlbns received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if 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 /> appacation may be submitted when the file is available, <br /> 4. Any file hot returned in the same condition as released will be reorganized by EHD staff at the expense cif the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> aw <br /> v. <br /> � a <br /> E:iO iS..C6 <br />