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Dec. b• 2UUb 10:23AM -- No- 0989 P . 1 <br /> DATE RECEivED EHD LOG NUMBER <br /> RECC` <br /> t.-,W i�.'!� SAN JOAQUIN COUNTY Ve <br /> �' t ENV'1rR0NMENTAL REALTH DEPARTMENT <br /> �p05 304 Fast Weber Avenue,3r'Floor, Stockton,CA 95202-•2708 <br /> �tL T�e�"one: (209)468-3420 Fax: (209)464-0138 Web: www,sigov.org/ehd11 ,57 <br /> -2LL���1 ,'�SPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT'._EF 1i A UJ 1-�I i� BUSINE$$IAGENCY: <br /> ADDRESS:_`7D II S , �AYr, LHN r' dW PL OO le CITY 1,6 DJ STAT1: �_ <br /> PHONE(1): 269 t, LZ rZ65 5 PHONE(I2): J _FACSWLE: <br /> TENTATIVE'APPOINTMENT DATE: /�/a / S Time,_ <br /> (Please&now 10 businw4 days from 4atebf appQ an submittal-'rentWm only-m be confirmed) <br /> ❑ C=HECK BOX TO EXPEDITE REFEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 6 SiNE`SS YS <br /> QU <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic p List o Map- pdon <br /> InfarRlAtlan <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 $beet Name City <br /> + ou�r tj IJ Unit 1 <br /> 2. 41 <br /> ILI <br /> s. O nit 2 <br /> 4. <br /> S, Unit 3 <br /> 6' Unit 4 <br /> r. <br /> $ ❑ Unit 5 <br /> s. <br /> �Q. Unit 6 <br /> Spec Date Range of Information Requested:From to l T li <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ERQP UND TANK(UST)CLEmup SITE(LOP) 17 HOMM AGATEMENT ,"I4ouo WA Te FACLjryjYEwcLF <br /> 0TWIt CLEANUP SUE(NON-LOP) t7 FOOD FACLrTY ❑WVASTs TIRE <br /> UwimimRoutwTAxK(NowrroklNuftMOVAQ t7 DQQ KENNEL ❑DAIRY <br /> WASTE CERERATOR 1� Tt RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIs xEo Pmm"Umn Eo FAmLm ❑MOTWI40-ML 0 PumpuR TRLCKrYARD10mE: uAL TouTs <br /> ❑TArroomQDY Pw-Rcjwa CI POOtJSPA 0 Gwo Ust APPLnAmoK Sys <br /> C3 fAmAcAL WASTE FAmLm tJ OTHER(PLEASE SPECIFY) <br /> WELL AND S epi PERIAm•REcoRas Am AVAILABLE FOR REVIEW-MONDAY-FRCAY 8:00 AM-5:00PU - Exuxuaw0 HOL"YB. <br /> t. List up to ten Addresses In.the space above. Select the type(s)of files from the Ilst above by checking the <br /> appropriate boX(es). At least one file type MUST be selected. Fax to(209)4134-0138 or mall to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3;00 pm will be processed the next business day. <br /> 2- The EHO wilt 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 /> application may be submitted when the flle Is available. <br /> d. Any file not returned in the same condition as released will 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 /> END 1696 <br /> �ars�aafls <br />