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1 111/25;'2013 08:55 FAX <br />■ <br />I■ <br />■ <br />■ DATE RECEIVED <br />MCEIVED <br />W3 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Cl 2 5 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPART"4.,��' <br />0�_ <br />!';nLTH <br />PUBLIC RECORDS RELEASE APPLICATION <br />2001/001 <br />EHDLOG NUMBER <br />APPLICANT: Ie) 6�o�, BUSINESS1AGENCY:662_,vr'Ccn <br />ADDRESS: ()-}5 ( � � ri.�, CITY/STATEMP: �0..Cr44'�A 0 nh3 , CA 9 2 i S <br />PHONE(1): PHONE(2); �f(o'n�Q2O�j FACSIMILE: 9(ic'�i��0(3` <br />TENTA77VE'APPOINTMENT DATE: 0j(?L/M« Time: <br />(Phase show 10 business days from date of appon su tm ttaT- ` ema e Only - must be connrmed) <br />CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE i0(2Si 1.3 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Stet • <br />80*a Name <br />City <br />itM►'►'1 � urdt z <br />a <br />r, n <br />- <br />` � <br />a <br />ff MO a1 L10 i 1 Lo j <br />tl�1iki �1'? MM Mf'�1P sUnit <br />Unit 4 <br />� <br />l' [� <br />LLL...,,,,...._...__..�_�` <br />5. <br />r6. <br />_. _..__._ <br />7. <br />0 Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />01 1 <br />spedfic Date Range of Infortnetion Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILP_5 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL. WAaT>• FACILITY ❑ souo WAsre FACLfrYNEHtcu �rl`QS <br />OTNEit CLUNUP Sr'e (NoN-LOP) ❑ Housm AeATENEw ❑ WAm Toth I <br />Ukma toUNG TANK (MowfTmNolREYovAL) ❑ FOOD FACILITY ❑ PA1RY <br />ABoweRouw) TANK ❑ CMIpCEN RANCW DOG KENNEL ❑ WAmwATER TnwTmmT PLANT <br />HAZARDous WAwTcMAzmtDous MATERLW ❑ MoTEL/HOTEL ❑ Pumpm TRx%NARa1CNEmrAL TVLETS <br />TIERED PER1tmm FACLRY POOL/SPA ❑ LAND USF Ali XATtON &M8 <br />TATToo1BoDY PIERCING iComPLAiNTIRrapomsp. RECoRDo ❑ OTNER (PLEASE SPECIFY). <br />WELL AND SI Q'(jc)o 1 `i 1ptJ`) ) 2 % `% , J) (a EXCLUDING HOLIDAYS <br />- I W P )e. ,, QV"P)a-//0_ nul robe,- - ling the appropriate <br />) <br />1. b x(u$). A Iolo I A6"1:1- ia.� Rpt Slog qq � k1y4� r f 5 Jot. Iry HLO X12 , :atad above. Address <br />ranges wll X03009, 32225, 3 . P ;talons received &nor <br />3:00 pm w Fro -v icud CLPPIJCOLO) u�if h I�Icrdc�>? t r� f .,urnbQrs X S S-0170 %, <br />2. The END M xsJ-oci97tl, xs.l -6JWLg far io►o ,.idutjrial , 1✓►�den�- rapor'� d approxirnatelyton (10) <br />days after numbers Ja>�R3, x5.1-:aa4ly) X53-aaSa B, XSJ-oa977, . low. Appointments <br />should be X3w - 001-7, )<S,) -0ggol �6(. 10D.1 iAdks�r� a/ , R640s 0Lpp)jC0✓,% <br />3. Afile that' wiW 0-rc-A - secrek uv1Q.,10-10L1o1)',-h) )e -t: kIL4 Rvr )Oz) /Rola rats �, newapplieat�onmayba <br />sunttwd t n gret4ibn f nC 4 Corn Paxi uci5 w k r wt hcvja.l . Prc;,,i teLo) cW l ),X rr�' <br />tx <br />4. Any file nc <br />Future file <br />O Recdrds <br />Received Tim <br />W m) Co qof . a `O\ S - %t r p r. ` �or Fi'LA�) ms; the • t[cant. <br />