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r *, I043, 2094626171 STOCKTOhi PETROLEUM C PAGE 81 <br /> - EHE7 LOG NLIMCt( . <br /> Sate JOAQU1N COUNTY . <br /> SEFP 2299= ENVIRONMENxA.L HEALTH DEPARTMENT <br /> ENVIRONMENTALy .304 E Weber'Ave 3td Floor Stockton,, CA 95205 <br /> PF�InIT'f S�� SS ` <br /> ���114n-3420 Fax: (209)464-0138 Web: www.co.san-jOaqu1n.ca.us/ehcL <br /> _ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> _� r: <br /> APPLICANT:_&r Te BUSINl:S51�AGEN,CCY,� <br /> ADDRESS: - 510'!5"— ✓rG�t <br /> PHONE: 17 r�T3 5'" FACSIMILE: ,a?vS�- Y�2- -/ 7 <br /> 0-7 <br /> I T NTATIV]*APPOINTMENT DATE- /�� /"{-S�_.� Time. <br /> r�1 (Please allow 10 business days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-RREOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /�/ . ' DATE L <br /> y .''ram .C��".• - <br /> Department Use Only <br /> FILE ADDRESS /yy� UNIT <br /> 7, 9trtel N 1' Ct f�. �1 rrz % V ,r` _ <br /> l 0 ._tic»» L.,IriUnit 1 �.,a <br /> Street Alf— Cs c� n: ,�f-T S8Z8ZOvdd��/� I4 l J <br /> 3. Streer C1 _ _. C' ~7 V �� Unit 2 " <br /> 1 (' :ii 7 e. S+aer r7 ;'n w/t,}f� <br /> `� 5. Street C�IY Unit 3 s I <br /> 7, Srrea _ G Unit 4 <br /> 6. Sheet <br /> 9ty <br /> city Unit 5 <br /> 10, Srner O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fUN13ERGROUND TANK(UST)CLEANUP SITE(LOP) 171HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 4 FOOD FACILI`TY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG'KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 1) CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELJHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> �. TATTOOIBODY PIERCING 0 POOUSPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> 1` <br /> List up to ten addresses In the space above.Select the type(S)of fifes from the list above by checkinc <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or.mail to the <br /> address Indicated abv . <br /> 2. EHD will notify the applicant If any EHD files exist. An appalntment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt bf application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly.• „ <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A nes <br /> y <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the experts <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie' <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS '. <br /> REVIEWED YES NO REVIEW DATE <br /> E O 4"2-096 —- - <br /> ututoo� <br /> a . <br />