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SAN JOA.QUIN COUNTX _ M•._ _. _ . _ <br /> AwhV-ONME NTA L HEALTH D.Ei PAIrMMNT <br /> 304 East Wcbcr Avenue, 3`d Floor, Stockton, CA.95202-2748 <br /> Telephoue: (209)468-3424 Fax: (209)464-0338 Web:'www.sjgov.org1ehd <br /> { <br /> PUBLIC RECORDS RELEASE APPLICATION '{ <br /> RPPUGANT: <br /> AD'v_ps5: it0 4J_ i{ ieUSIHESSfAGENCY: ^t �r�a�z_ KuLi„ A s c i <br /> 1 PHONE (i): Za'i 23 - ]772 PH4tt>= 2 X11 t6 4`r7�71 , ---�_ <br /> ( ?: FACSIMILE:. (��°? 23 1 -7717 <br /> TEN T AT{VE-APPo1MTME=NT DATE: 0(, ' `4— <br /> �� (Please allow 10 WSlness days from ate of s Time: Nl$;ri Nr <br /> Z'P tltioA su6mitfa!-C7 <br /> CHECK BOX TO EXPEOrM •Tentyg only-must be confi ed) <br /> • �• F { H OR C"ECK Qty)_PF-QUiEST PROCESSEt7'1?t 3 13USINF-SS Q <br /> s' 3:�(ATURE OF APPLICANTAYs <br /> �t �- <br /> t.. _ ..-.. DATE <br /> ~ . r_)1s7wBv7i0t! ❑ unif 1 ❑Nntt <br /> 2 d unit 3 D Unit t Cntt L ❑ unit 6 j ---~ <br /> Other(etectronicAistslmaps) <br /> - -- - FILE Ap[aR'ESS <br /> 5tlevt . Street Name EHD USE ONLY <br /> 1' 1 161 #1~r, aa,� Cityr <br /> 2. 5'L93 <br /> 3• 8e7 � �. q # f e- <br /> 4 <br /> - l <br /> e. r <br /> 10. j 40. <br /> tic Date Ftartga of Information Requested:From �) c <br /> to _ I <br /> f ENVIRONMENTAL HEALTH DtE PARTIVIENT FILES _ � � 3 <br /> 1 L1N06RCRCAND TANK(UST)CLEAMP'SrrC(LOP) ' 1100VOG A9ATumuKT <br /> J OTHER CLS-W rp SCM(NoN-LOP) IQ SoL10 WASTE FACtAYNEMOLE <br /> UrtpERGRO[R1D'rAW(M0Wr0a114afRF_PA )OVAL F000 FActLrIY 0 WASTE TIRE <br /> RAZAP.DOUs V"SrE GrRERATOR Dog KEDtM 13OAIRY Ali <br /> T'(EF.!.o f ER>MMD FACojTY d cK�J1 FiMH:N <br /> f <br /> ITATT(X:MODY' PER ❑ O TEd WASTEWATERTREArHFT ALNtf <br /> Q !F0,ALftSr FAcfLl PooOZPA0 PUMP1:RTRUCKNAPV0HEM101lr <br /> m <br /> ❑LA DUSEAPP0 AMNSnrs <br /> CJ orwn(PLr�SE SPEC" <br /> _• YELL Akre SEP11C F'r-Ju4T F�cc f41=ARE AYAr-.0loll <br /> R - MOMAY-FWQA-t 8"00 AFI-,:Oor* - E Cc Lrcx 4c HC(A]A s.. <br /> f un to fen addre.;ses an the space above. Select thatyk(s) of flies from the list above by checking the _ <br /> E-.rapriatc box(cs)_ At feast one fife type MUST he selected. ax to 209 464-0138 or male to the ad._ dress <br /> ..i;c�.tett at�ove._ Address ranges will not be accepted_for ttddltional assistance with fate addresses, es nt:s <br /> `<. <br /> FID. Applicatiolis received after 3,00 pt' will be processed the next business day_ <br /> SHi) will notify the applicant If any EHD tiles exist. An appointment for review will be confirmed <br /> i.):ox!mately ten (10) days after receipt of application. The riles will be held fora maximum of five busln v,. <br /> far reviQw- Ai}poin(n)enLS should be scheduled accordingly. <br /> :tic, that is a.ctivciy being worked on by EHD staff may not be Immediately available for roview. A new <br /> :;.c•�lction may be submitted when the file is available. <br /> ,ny fife not returned In the same condition as released will be reorganized by EHD staff`at the expense of ti117 J <br /> `pplicant. Future file reviews by the same appticant May require a$93.00 deposit,prior to review. <br /> 9 <br /> 4 ;2 400, •-- <br />