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FILE ADDRESS <br />SAN JOAQUIN 1.-uUN'i YPtidLIC hr_ALlh iL <br />V1RONMENTAL HEALTH DIVIS <br />04 EAST WEBER AVENUE, THIRD FLO4,0,‘ <br />STOCKTON CA 95202 <br />(200) 468-3420 <br />UBL1C RECORDS RELEASE APPLICATION <br />355 <br />APPLICANT. IQ/‘) L ee BUS INESS/AGENCY aduciAced & tilkVIVA6) <br />ADDRESS 4 /61 Or 4). Wdson Shackl-ori , CA 95-,zo_s-'-' <br />PHONE (//20 4/§ 9--1t9Ok, FACSIMILE <br />TENTATIVE* APPOINTMENT DATE 'cv TIME fl U2 k-A. <br /> <br />(Please glve 7 to 10 bLlIna4 days from dale of application submittal) <br />K CHECK BOX TO EXPEDITE REQUEST -7 .00 FEE EQUEST PROCESSED INS BUVIESS DAYA <br />eceovedDATE 16..A4 '7"z <br />JAN <br />Nj Ictct 0 G0,61- _________ <br />F cticu; erlA tWAv,)a n N _ton t \10%)G46 kt12-‘ t2 T4Z <br />-4 '2(101 <br />SIGNATURE OF APPLICANT <br />ENVIRONMEN-i <br />i <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON-LOP) <br />UNDERGROUND TANK (MONITOR)NG/REMOVAL) <br />I:I HAZARDOUS WASTE GENERATOR <br />EJ TIERED PERMITTED FACILITY <br />C3 TATTOO/BODY PE1RCING <br />0 MEDICAL WASTE FACILITY <br />List up to ten addresses in the space abN <br />the appropriate box(es). At least one filc- <br />ad d rpss indicated above. <br />EHD will notify the applicant if any El-ID <br />approximately five business days but nc: <br />will be held for a maximum of five busin <br />accordingly. <br />A file that is actively being worked on <br />application may be submitted when the <br />Any file not returned In the same conditi <br />of the applicant. Future file reviews by t <br />5.*TENTATIVE appointment dates must be <br />6. Applications received after 3:00 pm will k <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED YES NO <br />Eti DC 14 01/05100 <br />(A) <br />e - - OIL- <br />fed eA/ i€A00