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06/27/2006 10:53 FAX <br /> IEHD LQe HUMS=R <br /> DATE RECEIVED SAN JOAQUIN COUNTY 0. I <br /> FNmoNmE,NTAL HEALTH DEPARTMENT i <br /> 304 East Weber Avenue,3`4 Floor,Stockton,CA 95202•-2705 <br /> 0> Telephone.(204)468-3420 Fix:(204)46:4-0138 Web;vi'Ww.sjgvv.or;/ehd <br /> i, <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: FA BUSINESS/AOENCY: OIL. <br /> ADDRESS 4I Gia �l9 PHONE 1 FAGSIrfflLE: �+a ••• �. <br /> ( l:d y "3 c. _PHONE(2): t <br /> Tr--NTATIVE{APPOINTMENT DATE. <br /> (Pl@wo allow 10 buslness Or from date of application subr itWl-,Tentative only-must be conga ed) [� <br /> CO CHECK BOX TO EXPEDITE R U -393M F (C HECK ONLY)•REQUEST PROCESSED IN 3 BMIV�-�DSIGNATURE OF APPLICANT DATE 'Yi <br /> UNIT Dt3TR46U tl[7N C7 Unit UniE 13 Unit 3 ❑UnX4 ❑Unif 5 13 unite 0 Othar(6loctronIdII2tSlm8p:i) <br /> FILE ADDRESS EHD USE ONLY i <br /> Street d '- 5treet,Kama City _ <br /> 4. 1 b 1Z. RAC H ki WIL_tj�3-__--- v- "I+i.. . <br /> ! <br /> KBIML JA <br /> Specific EY2W Range of Infomistion Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1UNDERMOUNDTANK(UST)CIZANUP SITE(LOP) 17 ROWING ABATEMENT E3soLn WAST€FA=jTYiVMCLE <br /> OT NEE"EANITP S�(NQN-1,9P) 0 MOD FACILITY ❑WAM TIRE <br /> UNOERGROADTANK(FA0mT0RINa1RE3YIOVAL) ❑Dm KEMEL 13 DAIRY <br /> HAIARmus WAmm GENERATOR C1CIRCKEN RANCH Q WA$TEwA7ER TRJ:ATMENT PLANT <br /> ❑TIEREDPERMrTTEDFACILITY 0 M07MJHOTEL - 'u .Q PUMM--ft7RU0KrYARW0REMT01LET5 <br /> r ❑TATYOOMODY PIMNo =PoaAPA ❑LAND USE APP1,Jcxnoti Su Es <br /> j ❑MEDICAL Mum FAcRm El OTMR(PLEASESPE(N <br /> WELL AND S11731C PEWIT MCOM AR6 AVAILO R FOR RIMEW- M0NDAY-FRIAAy$,W Ap15:00FM - EXCLU'uM HOIJUAYt, <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 /> appropriate box(es). At least one file type MUST be seiacted. ,Fax to(2091464-0138 or mail to the address <br /> `ndt icated above. Address ranges will not be accepted—for add itlonal,4s5istanre with file addresses,contact <br /> t the EHL.Applications 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 vYill be hold for a maximum of five 6uslness <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 /> t appficWon may be submitted when the file is available. <br /> j 4. Any hie not returned In the same condition as released wilt be reorganized 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 /> a -- <br /> 7i_ _ <br /> EFIG 48-p�-0D9 <br /> fM4t06 <br /> I <br /> F <br />