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F,--'_'/25,'2013 08:55 FAX 16001/001 <br /> DATE RFCENEO EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY ��� ' EH <br /> ,VEVVED ENVIRONMENTAL HEALTH DEPARTM 'NT1 . <br /> 186B East Hazelton Avenue, Stockton,CA 9520532 U <br /> -62 <br /> QCT 2 2013 Tolophone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.orrgfehd <br /> �otMMEWM-"EA-M PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .A pj(aC o 4, BUSINESWAGENCY: <br /> ADDRESS: CITYISTATEMP:,Igo-ce apA b n CA TO i S <br /> PHONE(1). �I d'�SCo _ PHONE:(2): FACSIMILE: 9��a-�����C�' <br /> TENTAPW APPOINTMENT DATE: 1112 A Time: <br /> (Prsas�agow 10 bua3nses days trorrz date o RAp on su31T an'l�lr ve onijr-mua!be oonflrtnei) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE i0(ZSI 1, <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHO u W ONLY <br /> st►..c# su..t Namecp <br /> CFq► - • ,UNt f <br /> • •-- `` r� �P tic� <br /> �,=mP t7 Ln-( �1LC�.tJI.��(C�.h i�f•f�..,. � ti (:(7� <br /> ,., i <br /> I/ 5. <br /> 8. M/UnitJllCep l <br /> 8. W Unit 5 <br /> 70. ❑Unit 5 <br /> Spacfic Dahl Rm*e of infofmatlon Requeelmd: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDOMMMD TANK(UST)CLEANUP Srm(LOP) MED=L WAare FACM f ❑SOLD WAste FACrLnYNEHGLE <br /> 19 oTNmt urmuP STI't ob"OP) H Housura ABATEmw ❑WASTE Tins I a <br /> liMMOROUM0 TANK 01 IOW"NNoIREuoVAL) ❑F000 FAcu " ❑DAuty <br /> AsovEoRom TANK ❑CMICKeN RAUCW D00 KENNEL ❑WA$MATERTILCAT*fAT PI. MT '�l <br /> HAZAI MX WA9t%AWA%WW MATt'.RUM ❑1V OMLMOTEL ❑PUmPo TrnCKNAWCHEMICAL TOILETS <br /> TIM=PalwrM FACLM POOLISPA ❑LmD Um APPLICATION Sne <br /> TATToo/BODY PIERCING ComPLA4lTIRnPON m REcom ❑OTHER(PLEASE$PECIPY) <br /> WELL AND Si tiers Q r)cC>I q 41 q ) 1/,5Y&,r ji (ExcLuDING HOLIDAY <br /> 'f. list up to 1 �or0 i rL(jv icj Rel'�1C10 rr' �W F11e., Cca�rpla��r! rlurlsb�s ting the approprlete <br /> 32225, � � rpfi 5lato �.� !!u� ale :atedabove. Address <br /> ranges wll. ' 34 qCq, :etlon:i race�ea after <br /> 3*00pmW, Qfra/r&Ci a.PPlrcarr� w'H' tnc.rri��t ,per} numbers xsS-�I70�/ <br /> 2. The END v xsS-000-q, x�J-alaa�f f6r }aro ,.�clu Tial, frl�cl e,�� r�C r� d approxynatelyten(10) <br /> days after �umners. 1cv3q�, x5� �t<a�lry� X5J-ff sad, xsJ -ca9�7, low. Appointments <br /> should be Xis - oyor-7 , x53 -04461 Por )D:Ll }ndks�ria/ . ptb4ia c� applfcckd <br /> 3. A file that I x�rr�� cr arra r4 aL�c 1 ff le tc� Jo naw application may be <br /> submitted trigrec(ian dna Corti Prc�UCis �nernc�ftona( < �t,dICS g7�1�1lr <br /> 4. Any file nc u71� �G7 P,trpor- �or 4,uo mseofthe a Ifcant- <br /> Futum Me <br /> ds <br /> Received Tim <br />