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Jul 05 06 10:00a Apex 209 °`7-9668 p.2 <br /> DATERECEUED Q-iDLCC MUWRER <br /> D <br /> ( � ` SAN JOAQUIN COUNTY <br /> Ula!�+�„ jD) ET1MONWNTAL HEALTH DEPARnIENT <br /> 304 East Weber Avenue,3`d Floor, Stockton, CA 95242-2703 07 <br /> !JL 0 5 2L, Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd <br /> ENVi'i?011 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLI f: G�► ^ BUSINESSlAGENCY: <br /> At)cir.,Ess:_TI`4 �.,► .Q rt wt Z-u,r t'K _ <br /> PHOh1E(1l:Zr3b1 �• ��.. h` { PHONE(2): &�T 6`l e - y t-147— FACMiL>- <br /> TENTATIVE'APPO MiIENT DATE: �'��t -r w C l`�� <br /> (Please allow 10 business days from date of application submittal-*Tentative only-mast ba coiYir ed) <br /> © CHFiC�K SOXTO EXPEDITE REQUEST-$43.00 FEE(CASH OR CHECK ONLY)-REQUEST FR cEssEDIN BUSINESS IV"tYS <br /> SIGNATURE OF APPLICANT Off`--V� DATE: � ����► <br /> UNt7 DISTRIBUTiCIN ❑unn i 0 Unit 2 O Unit 3• O Unit 4 0 Unit S 13 Unit a ❑ other(elect DnicdS tsima fs) <br /> FILE ADDRESS EyO USE ONLY <br /> Street# Stiest Nane City <br /> 2. 4.L44 N �}, <br /> 3. ZSR 3- " J <br /> b. `1\\ <br /> 6. <br /> 7. <br /> NO <br /> S. <br /> 9. <br /> eta. i <br /> SEIecific Qlate Range of ITtformakm Rearuested:From Z.ND�4 to eAa 0,/N,}. <br /> .�,/ EtMRONMENTAL HEALTH DEPARTMENT FILES D <br /> . UMERMOUND TANK(UST CLEANu?SITE(LOP) 0 HOLISM ABATE?V{Et(T ❑SOLO WASTE FAC UTYNEW-LE <br /> 4 CITHER CL1Eo&I;m SrrE(NON4_oPI E7 FWD FAcn iTY 10 wAsTz TIRE <br /> C7 L7rVERGROUKO TANK(MOMOMNGIPZk OPAL) ❑DOG KENNEL, 0 DAIRY <br /> la KAzctRDous VVJL-,TE GENERATOR 13 Cry RANCH Q ViAsifwATm Thc-Ar*wr PLAear <br /> ©TIERED PemmTTED FACtLm ❑VOTEL1 oro t3 Fump t TwxrUYARD1Cw.i TQir.m <br /> Q TATYOO/BODt'('ICRpM 0 POOLISPA 13!AxD UsEA?PI-CATIM SITES <br /> MEDICAL WASTE FACU Y a OTHER(PLEASE SPEaFY) . <br /> —_Wr3L AND SEPM PSI�Mrr REOORDS ARE AVAu.AME PDR REVIEW- KoUDAY-FRIDAY 8:o0 AMI.S:00Plt - EKcujoejo HauomT. <br /> I. LLSt up to tan addresses In the space above. Select the type(s)of files frOM the list rbovf,by checking the <br /> appropriate box(es). At leas one file type MUST be selected. Fax to(209)44;4-0138 or mail to tlx3 addrelis. <br /> indicated above. Address ranges will not be accepted—for additional asscstanc>ewitth file addresses,contact <br /> the EHD.Applications received after 3:00 prn will be processed the next business day. <br /> 2. The EHD will notify t(ie applica�at If any EHD files egoist An appointment for review will be Confirmed <br /> RPIPrOXImiltely ten(10)days after receipt of application. The files will be heicl fora maximum of five berS nes; <br /> days far revaew. Ap faointme nts should be sdwduled accordingly. <br /> 3, A file that if;actively being worked on by EHD staff may not be irrlrrmed otely available for review. A nam? <br /> EIpplica'tion may be submMec when the file is available. <br /> 4- Any file Wit mturned in the same condition as released will be reorganbr-ed try EHD staff'W the expense of bile <br /> applica�-at Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> eras atwz-0as <br /> �rt,uns <br />