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`AR 11 2009 1 : 57PM AMMSTAR CORPORATION 5109530980 <br /> p. l <br /> 03/11/2009 11:56 2094608 ENVIRONMENTAL HEALO PACE 01/01— <br /> PATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 606 East Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)464-0136 Web:www.sjgov.org/and MAID. 1. j9 <br /> PUBLIC RECORDS RELEASE APPLICATION ENVIROl',i+. '�f ZEAL TH <br /> S APPLICANT- (. RUSIN ESSIAG EN CY: <br /> -j ADDRESS: 3 OSS 6)56-60D �y a. WI, C.4 . J3 � <br /> PHONE(,): S I D L & PHONE FACSIMILE: !;f>60 <br /> 0 <br /> TENTATIVE*APPOINMNDAT j " <br /> Time: (I at" <br /> (Plaasp allow 10 buslnesa m data of appll atlon submittal-*TankAv only•must be coo lrmed) <br /> ',CHECK BOX TO EXPEDITE REOW ES - 0 EE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSIN S$DAYS <br /> .SIGNATURE OF APPLICANT DATE 3 f? <br /> Electronic into rmation: ❑List❑Map—Description: <br /> k <br /> FILE ADDRESS EHD US LY <br /> Straot rf 61mot Name city �] Unit 1 <br /> cf 3 u 7r vJ G15e <br /> �y 2. 1] unite <br /> 4. ORO <br /> Unit 3 � <br /> 6 ;jpU06- <br /> 4 <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10, <br /> Specific Date Range of Information Requested:From C �S'P to &4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HoWiNG ADAT�MENT E3 sotjo WmTE FAGILITYIVEMCLE <br /> HER CLEANUP SITE(NON-LOP) D F000 FACILrrY 0 WASTE TIR' <br /> NOERGROUNDTANK(MONiTORINGIREINQVAL) ❑Doo KENNEL 0 DAIRY <br /> t1A?ARDOVB WASTE GENERAtOP. CZ CHICKEN RANCH 0 WAsrewATER TF%AT FNT PLANT <br /> ATIEWO PERmir=FACILrrY ❑MmUHOTtL ❑PUMPER XRUCKNARDIMENI 701UTS <br /> Cl TATTOO/Boot PIMRCING Q P00L/5PA ❑LAND UsEAPPLiCAmN SITES <br /> MtNCAL WASTE FACILITY Q OTHER(PLEASE SM" <br /> WELL AND SEPTIC PE norT REcORM ARE AVAtA9LE FOR REVIEW•MONDAY�FmDAY 8:00 AM-5:00x.+ -rxci-mr4c HOLDAYA. <br /> 1. List up to ten addresses In the space above, Select the type(s)of tiles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fa. o(209)464-0138 or mail to the address Indlcated above. Address <br /> ranges will not be aoCUptad—for add itlonal assistance with flle addresses,coritaatthe EHID. Applications received after <br /> 3;00 pm will be processed the next business day, <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for revlew will be confirmed approximately ten(10) <br /> days after recelpt of application. The fifes will behold for a maximum of five business days for review. Appolntmenta <br /> should be scheduled accordingly. <br /> 3. A Iiia that is activeiy being worked on by EHP staff may not be Irninedtataly available for review. A new application may be <br /> submitted when the fge is available, <br /> 4, Any file not returned in the some condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviwir by the sanTa applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> 3- s d- l4 <br /> EHD 46 B 04100 PUBLIC RECORDS RELEASE APP FORM <br />