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DATE RECENED SAN JOAQM COUNEHD LOG NUMBER <br /> TX <br /> ENVIRONWNT'AL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 34 Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 pax:(209)464-0138 Web: www.sjgoy.org/chd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 5EI31NESSlAOENCY• <br /> ADDRESS: Aik <br /> RHONE(1): W621—d'R.71 PHONE(2): ACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE. : <br /> (Plains allow 10 bwlaiaa days from da of a pllcatloa submittwl. Twdatlw only-must ba eooflm ed) <br /> © CHECK BOX TO EXPEDITE REQUEST 01 CASH ON CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION C3 Unit 1 d Un Unn 3 O Unit 4 O UM S O Unite 0 Other(vWctmnkAlatw%mpa) <br /> FILE ADDRESS <br /> atrrat a stmt Name City EHD USE ONLY <br /> 1. Al <br /> 2. <br /> 3. <br /> 4. <br /> 6. <br /> 6. <br /> 7. k <br /> Specltk Date Range of Intormadon Raquastad:From to <br /> — - -- _--------ENVIRONMENTALHPAL4H-DEPARTMENT-FILES <br /> Jd UNDRRCIWUAD TAW(UST)CLEANUP SITE(LOP) O HOL104 AoArwENT 0 SOLID WASTE FACILIYNEHICLE --- <br /> O GTHER CLEANUP SITE(NON-LOP) 0 F000 FAcury G WASTE TIDE <br /> JD UNMWtOWD TANK(MONITIMIC REMOVAL) (3 DW KCL O DAIRY <br /> M HAZARDOUS WASTE OENERA70k ❑CIOCKEN IIANCH G WAM MIATER TREATMENT PLANT <br /> O Tmm Pumvrmo FACIuTY 0 AAMUHOTEL O PUMPER TF=K/YARWCHE>M Tokm <br /> C3 MEMA WAASSTE FAYCIUTY 13 PICROM C3�(PLEASE SPC�1FY) d LAND US!APpLIG11T+ON am <br /> WELL AND SEPTIC PERMIt RECOKM ARa AVAILAOLE FOR REVIEW- MONDAY-I'MDAY 4100 A 4:OOPM - EXCLuDINa HOLIDAY& <br /> 9. List up tq ten address"In the space above. Select the types)of files from the list above by Checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 120914"-0138 or mail 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 END will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(90)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 file Is available, <br /> 4. 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 applkent may require a$93.00 deposit prior to review. <br /> 3N <br /> IJ14M <br /> TO 39Vd Old OlSMOW 9ZZZ-6L9-60Z T9:TT SOOZ/VZ/TO <br />