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P11/25;'2013 08:55 FAX <br />6� <br />I■ <br />r DATE RECEIVED <br />SAN .JOAQUIN COUNTY <br />vitk Jv.. ENVIRONMENTAL HEALTH DEPARTMENT <br />M3 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />jjC 2 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />Z001/001 <br />EHD LOG NUMBER <br />APPLICANT: F -In 6BUSINESWAGENCY: 6 i� <br />ADDRESS: I1fSi iV �. bri.t,-� CITYWATEMP:'q0,c,ra,"NAp fl f13 , CA q�a�i <br />PHONE (I)-. PHONE(2): FACSIMILE: 9(( A3p 0-00.3 <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Pieaas *How 10 btWnase days from deft o e7—Epp Icon sum ems ve o - must be confirmed) <br />CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT � DATE IS <br />Electronic Information: ❑ List ❑ Map – Description: <br />k <br />FILE ADDRESS <br />EHD USE ONLY <br />str"t 4 <br />Swat Name <br />Clgr <br />....... <br />1110f <br />r�MVN Unit 2 <br />- <br />N' <br />�' <br />c' , <br />4,IMM <br />i <br />1 C(5 <br />MM mMP upas <br />E]/Unit 4 <br />5. <br />6. <br />7. <br />Unit b <br />9. <br />❑ Untt 6 <br />10. <br />specific Dade Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPAR71WIENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTL FACILITY ❑ soon WAnE FActmNENtcLE <br />19 OTMWt CLEANUP SIT! (No"OP) ❑ Housm AMATEMENT ❑ WAM TOM 1 <br />UNMGROUrn TANX (MONROFJNGIREYOVAL) ❑ FOOD FACILITY ❑ DAIRY �� 1 <br />ABOVEGROUND TANK ❑ CtirmeN RANGW Doo KENNEL ❑ WAeTzwATER TRCATNII%T PLmT <br />HAZARDo(x WMTeMAzAnpous MATURIAI,A ❑ MOTELIHOTEL 0 PuMPPe TRucKrYARWCNEurAL TOILETS <br />TIERED PmR1tmm FALL rrY POOL/SPA ❑ LOD UaE AMLICATM SnS <br />TATToo/BODV PIERCING iCouPLANT/RraPowIsF- RECORDS ❑ OTHER (PLEASE $PECIr1Y) <br />WELL AND SI r nUm AUL' 01 y (,-y1 r 12 qi l -S9Zo r 1 S ��, �Co,- (EXCLUDING HOLIDAYS <br />-� , w File.. lai�rt /►u�nbf, cI thea to <br />1. up16I 10Io I v16LA. ifi ial KPfi' 5106 r� <br />es A 3y �� 32225, )$ `�� . za /`/4L rpt 5101, i.4 Nu3 �J� , .etsad above. Address <br />ranges wll <br />3:DO pm w <br />2. The END v <br />days after <br />should be <br />3. A Ale that <br />sutxnitted <br />4. Any His nc <br />Future rile <br />7Reddrds <br />Received Tim <br />�v , ;utlons recur vod atter <br />Qra.VIc� cyplIC0,01 diFh IAalcie�t �yar! nu.nber> X5,j-6/70q, <br />xs,i-oo97�1, xsJ olaa� For role dapproxlma%tyt•n(10) <br />numbers 1 �3Ra, xss aa��9� XSJ-�aS�B, xsJ-aa9�7, iew. Appolrrtments <br />Xg� - vyol'7, xsJ -o4yc)1 Por ►oa-I IAdtstrind , P(bJtAzz� oappb:�ca <br />w I z i re.a� sQcrek u11a 0001 aloe) 'Jt) IetU/W rOr JOE) lnol amoral' Qf new application maty be <br />In9rec(ion lnc 4 Corn P�ucis 1'1�errta}•/orcal - rprvJLCW ��lcxuri" <br />'N1Fpr*' �-r HLo �11e,. ;:k;d mseofthe applicant. <br />