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M•G f�O�.WYCv <br /> REUOV ED ENVIRONMXN7'AL HEALT111 DEPARTMENT Q <br /> 304 East Weber Avenue, and Floor,Stockton, CA 952022708 I <br /> JUL © 2005 Telepbene:(209)468-3420 Fax:(209)464-0138 Web: "-Nv.sjgov.orS/chd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ADDRESS: B Sf�cc! l�>yw . CA �yS4 1 <br /> PHONE(q: 510 a1u701158 +aoa PHoNep):_`ill FAcsuaeE: S/d-BSG S3Y9 <br /> TENTAM'APpoi"Tw12NT PATE: Tom; <br /> (Please allow io business days tray EAy of apaGdtlm wT &nnly-mutt a oo�finmed <br /> CHECK BOX TO EXPEDITE"QUEST.ia7.te PrA(CASH OR CNECN tmt.vi-FEQUEST pROCPE7ti0 UI�Bus $ <br /> 81QNA RE OF APPLICANT DATE _ <br /> UNIT DilTRle{UTtON ❑unu t o UiNt t a s ❑tk*S o Unna o Oawv(cites-e�gCAtatshnapa) <br /> FILE ADDRESS_ END USE ONLY <br /> btwt a Stmt Naha <br /> 1. tJ_as v i fg�ow 9 <br /> ✓3;,__1 - <br /> 3. N Ac 4- <br /> 4.4. <br /> 5, wien �y <br /> 61 <br /> 7. <br /> a. t -- ---- -- <br /> 10. <br /> Ipeaafc Date Rangy of Information Requeskd:Fr ��--. (._ �L,�, <br /> / ENVIRONAA ENT&L HEALTH DEPARTMENT FILES <br /> !!-` ouwo <br /> TAW(TAST)t .MWS aih(LOP) AaArwrxr ❑ WAS71:FACsm <br /> P*-CAW*SITZ(NOW") FACam O wAiTE Tqa <br /> Vas�ouw TANK I ararow�wmeaovALi a o Due. <br /> wAara aawrmAroa r.0. R�MFN a WAMNATtn TAUMM PLANT <br /> Trm®PaRrmu FACIUTr ", <br /> a(oreJHO ❑PUYpaq TatttpuYAatAk',nkM <br /> ttialFi4 <br /> t7TArmOroanvPmrAWO 'nPOOIliPA DLANOUNAM- cArmS,yce <br /> G MCW-4A.WaaTt FAewrr ' in Onim(PLUau t+acrrl <br /> , WalA/oltrneftMe NAnAvNimupcaRav Y- MaHOAr aoArt:00AMCoaw _ ExcivawoHot"YlL <br /> 1. List up to tan addr"ses in the space above. Select the typ•ls)of files from the list above by checking the <br /> aPPMPftsW box("). At Nast one file type MUST be selected, fax to(20914(244138 or mall to the addresx <br /> indicated■ • Address ranges will not be accepted-for additional"Ststant•with file addresses,contact <br /> the END.Applications received after 8:00 Pm will be prooessed the next business day. <br /> 2. The ENO will nobly the applicant U any END flies exist. An appointment for review will be confinnad <br /> approximately ten(10)days after receipt of■PPOCAtion. The flea WHI be held for a maximum of five business <br /> days for revitw. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by END staff May not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not lvtumed In the same condition as released wal be reorganized by END staff at the expense of the <br /> applicant. Future flie feviews by the sane applicant may require a$93,00 deposit_. p prior to review. <br /> �a wm.wi <br /> TO 39Vd -1tilN3WN0dIAN3 SV63 66£5988 �£ 500Z/6UL0 <br />