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DATE RECE <br /> IV <br /> ED SAN aJOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> / 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> V Telephone: (209)468-3420 Fax: (209)464-0138W eb; www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION 11 <br /> APPLICANT: 041441e?9 BUSINESSIAGENCY: 2 L�1.� <br /> ADDRESS: g/ e l/ R 4,Q CITY/STATE/ZIP: &.,kt Fes* Is co <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE.*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 14CHECK BOX TO EXPEDITE REQUEST-$125'FEE(C H/O�CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE.OF APPLICANT DATE <br /> DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> \� <br /> Street# Street Name City FtflO <br /> W 2. yetd-P 16A 194._d ,r NI>h H MP WOP " yl� <br /> 3, Tr 'Nna-1Dwer < so(-t U4' i v<zs r a, _/nit3 <br /> 5. <br /> 7. CG Ne S'Fr4.c. <br /> $' 6 Kof} EI Units <br /> 9. <br /> 10. <br /> ❑units <br /> Specific Date Range of Information Requested: From T 1 /'Z(510 to 1rr7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ' <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> MOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE I( 14)e15 fo!!/f f f3• <br /> 1❑1��l'U'''N""DERGROUND TANK(MONITORING/REMOVALV ❑DOG KENNEL ❑DAIRY <br /> &4AZARDOUS WASTE GENERATOR( ❑CHICKEN RANCH ��--yy E� T PINT <br /> ❑TIERED PERMITTED FACILITY Lam-WASTER TRUCKR ATMENTPLANT <br /> ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA R LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY R COMPLAINT RECORDS OTHER(PLEASE SPECIFY) 71c 94-, mbovV L <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List unto ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mall to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. . <br /> 2. The EHD will n qq <br /> days after rec 1-IS-13- 111 P �I!61 nm (AM O�Uin ?A$ 1 n �)(�.. %OW P.✓' It7A•'� p Appointment's at a ten(10) <br /> should be schf 5c)r t/MA+ nn Fr 81, C9 35315, wO`D2sa67, 20002 ' Appointments <br /> 3. A file that is ac C-000ot1-7-7LD0170�I2, I L000(ge3,2, CQ-900 343 - <br /> .wappl)cation maybe <br /> submitted who co00a3240i O3_21t � i <br /> 4. *Any file not ret- m0at354+9j"053� 9a013a <br /> Future file reel Loq PI aunt# l.D17t)88 J aha..aw fiI�k7Y^De I 14C ,�.e of the applicant. <br /> tp o � <br /> LDAlpladnF �LCD ro41(6YOf�c1FWO) 07Irpr5,Ow a.,-8 ,q <br /> _ no II S-y Alp (D/ -F0 ,1 ,- Pa.vIC Mn." n <br /> 7-15.13: VroU:coca a jIiw,7 [OP,f 5 of Y-lu_f01/0w, Ra-&MOS"1 na <br /> monr`I-s ' e�-�44(, f5�-0�3t� j,7;-Zp3F, , 1121a r_ <br /> EHD48-06 — _ __., .., ",IUA 111 . nhatul 5. i2V-l1I1ID5L4iZ1 e1 � <br />