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Nov 28 05 03:26p Apex 2C 67-9668 p.1 <br /> x€.g cEIVED <br /> ` , ' n LOG 1u1usER <br /> ( � SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL.MALTH DEPARTMENT <br /> 40V 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> Tw wMEALYH <br /> CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D rcw av\ 1l-ptw BWlNESS1AGENCY:__ Adm <br /> JMRESS: Z"� t�► s. �e ut- es f is e k c,,S 3'B Z . .. <br /> PHOME(i): ?rot fat* PFraPP_(2): FAasdtrF- LZ' iia'6-4 <br /> TENTATWE"APPOmNTME:NT BATE I z f `4r- True: d QO <br /> (Please allow 10 business days from date of appikaHon subrnMzl-•Ter*iffve Dniy-must be coo8nned)— <br /> CHECK Bax TO EXPEDITE RECIUEST-$93.00 FyEE,�CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3US1DAYS <br /> SIGNATURE OF APPLICANT 1�'"�� DATE I1 tZ�d � <br /> UNIT DISTRIBUTION O Unit i O tinct 2 M Unit 3 UnR 4 O U;*5 O Units 13 other(electrwr Cnfttslmaps} <br /> FILE ADDRESS EHD USE ONLYStreet i< street Nano CiEp <br /> - tA ei..ra r+_ �+ k- <br /> 2 d 1; C44- (_'4" a <br /> 1*.5 S atm a SL q <br /> �i ea s <br /> s dzl 4 C n <br /> t <br /> 7. NtwfV4b^ R-4%4 -- <br /> 34jf— <br /> Specific Date Range of Information Requested:From to t1r4 4- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )RtNDE:tWWUND TANK(LEST)CLEANUP S M(LOP} 17 Houstwo AaATe wr O SOUD WASTE FACLITYMENME <br /> O OTHER CLEANUP SITE(NON4.OP) O F000 FAaurY O WASTE TME <br /> 0 UNDEli ROUND TANK(WzNrmmNGrRmwAL) La DOG Kemm 0 DAMY <br /> M HAzARDovs WAs'mGENERATOR O CHCKEN RANCH 13 WAsrewATE3tTWATMENr PLANT <br /> O MaFm PERmrrreo FAauTY E3 tioTELIHoTE L O PUNPFR TR KWJYARb1CmEm Tou.ers <br /> O TATTOOMODY PWJ=NG t7 POMISPA ❑I.ANo Usv APPLIcAM N Snul <br /> O II MCAL WASTE FACILITY O t?i m(PLEASE SPEC <br /> WELL AND SEPTIC PERB<r REMms ARE AyAms m FoR REVIehI- umDAY-FmAY&*o AA4:o9PM -ExCLUDwG HOUDAY& <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 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 EHD will notify the appricant if any EHD files exist. An appointment for review Y411 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 hrunediately avalllabie for review. A new <br /> application may be submitted when the file Is rwailable. <br /> 4. Any file not returned in the sante 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 /> - :fir•' ., - <br /> EHD 494X4M <br /> 114445 <br />