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1 13:06 <br />FAX 31061541744 2001/001 <br />004/15/2014 <br />I <br />IR DATE <br />r <br />EHD LOG NUMPIER <br />PIER <br />SAN JOAQUIN COUNTY <br />`(� ,``., <br />' E� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 96205-6232 <br />APR i <br />Wglephone; (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRO <br />HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />APPLICAN T•. ,,� <br />BUSINESSIAGENCY:� <br />ADDRESS: <br />CITYISTATE)ZIP: 0 UN f 9�'3 � <br />PHONE (1): <br />- j PHONE (2): FACSIMILE: S <br />TENT <br />VE• APPOINTMENT DATE: L1 (`� f 4 Tlme: () AM <br />_� <br />( lease allow 10 business days fl-om d A f opplicatlon submittal - *Tanfative only - must be conflrmod) <br />[� CHEC <br />XTO EXPEDITE REQUEST- $125 FEE (CASH OR C CK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF <br />APPLICANT DATE (I ( T <br />EI`ctronlc Infet <br />anon: ❑ List [] Map -- Description: <br />FILE ADDRESS EHD USE ONLY <br />Street# ; <br />Street Name City _ unit 1 <br />J �� <br />ot <br />2. <br />v� t <br />N <br />r�k5 <br />M <br />3 <br />i <br />int,n nC�6 <br />'QLL&t? <br />Q'Tit0.[/^f'f1P�1 SST' ML Q'tk� �s S+ cow <br />�I <br />Specific Date <br />KUNOERC-ROUND T <br />OTHER CLEANUP; <br />EUNDERGROUNDI <br />ABovi:-GROUND <br />TZ HAZARDOUS WA� <br />(LTiERM- PEINlrrd. <br />Lj TATT(mlBoDY FI <br />WELLAND SEH <br />1. List up to Ifb <br />box(es). At It <br />ranges will n,, <br />3:00 pm will I <br />3. The EHD will <br />days after reg <br />should be sc <br />3. A file that 13 <br />submtdod wi <br />4. Arry file not t <br />Future file re <br />Received Time <br />Unit / <br />V <br />a <br />I I 'W unit s.I <br />f Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />(UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTE FACIUTYNEHICL.E <br />__(NoN•L®P) ❑HOUSNeAflAMEMENT WASTETIRE ` 3 <br />(MONRORtNCIREMOVAL) [ FOOD FACILITY DAIRY <br />CWCKEN RW4CHI DOG KENNEL WASTEWATER TREATMENT PLANT �' t <br />HAZARDOUS MATERLAL6 ❑ MOTELIHOTEL PUMPER TRUCKIiARDICHEfd[CAL70M 1=i S <br />ACILnY ❑ PDOUSPA ❑ LAND USE APPLICAT10N SM <br />ING COMPLAINTIRES PON SE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM- :OPM (EXCLUDING H01-IDAY5) <br />(dresses In the spar-® above. Select the type(s) of files from the list above by checking the appropriate <br />A one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above, Address <br />tIe accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />processed the next business day. <br />Itifythe applicant if any EHD files exist. An appointment for review will be confirmed approAmately ten (10) <br />pt of application, The files will be held for a maximum of five business days for review. Appointments <br />duled accordingly. <br />E/ -174j' t4"1 ap�icc4tl ccr��l cif jJCi2LYttJ9 r_urtei�oPawk�f`Zo of <br />.hely being worked on by I <br />> the file Is available. Cjlao-L J1ev� l j- 3+ 1 �6r- 720 fk+ribiter UI Pb�r Aub roNSr AtAfo iune�brr,tc� <br />tmed In the same conditio `;q 0 i Tres, cV+uc-ks Aulor�epai-,% 1 -D 4-F ve, Nlunxfi:e/i tr1o54e7-lk l <br />l fPr �'eci! Peru 51r7m cexkl- <br />ws by the same applicant NLnraiYto�7 Nl.askr-cir, Mw�ler �ecYt� Mu r <br />5 -7 ;r m or I Lie s pr -a y -on �uilvlrS <br />;..t, },;�r,;,a..g ; "':�t'�e'�--••w... SPr�;f t.1t b,:t{I�rtct-S Lir Pro+( -c, p ars o� A/ CcO. r <br />": ,,,1.. r;i==', Tor a 6•R.;.r. ^• ti. - <br />: srcr=k4pcltd czok-r, C0061`6 q �cr Yurcn 77b1 T,rt <br />;max ko�shankz cpi �►�tc is ►n tFus Rile, pmvid.ed copy oR 01o00o3�a-6 <br />41V ilL-I <br />�_•�:. �; (rpt- �)0(r) tp-- -77-0Hai-nlgel-, Pravtdac(. CA aF Sao ►aw71nU-L <br />liw Rle. -T Hta. i Us` frlsfue( Cc.'�t(8 . <br />' 701 t a.>1 ► ai►�r� <br />C¢�t'►'1Ql p-ut�' C17LY037F1.� 3 CGi / o X87) 1S ;�� NW A/e... stoma <br />Apr. 15. 2014 1:16PM No. 5793 fb,— 72.0 miner to v"GZ -41aNe 64944 AL:�- <br />