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09/14)20 5 0:09 FAX 9162905429 WKAsENVIRONMENfAL /0002/002 <br /> TDA © u SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 14 2005 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> ENVIRONMENT HEALINeTbone: (209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION ' <br /> It <br /> —�� BUSINESS/AGENCY: <br /> ADDRESS: 3050 �,,.{..f 4 r,'4 ( RVA We.$f .$-< a/e n+.- �3 C^. 9s-6 ?/ <br /> PHONE(1): 9/6 _ .3 27 /�3 PHONE(2): SyZ 9 <br /> FACSIMILE: 9�fii '.Z 70 - <br /> TENTATIVE'APPOINTMENT DATE: 9• /9• 0-1-- Time: 0'10 J <br /> (Please t <br /> allow 10 business days frau date of application submittal-'TentoWe only-must W con" <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B -- <br /> SIGNATURE OF APPLICANT -- DATE '7//,/.. <br /> UNIT DISTRIBUTION 0unK1 E3 Un Unk nit4 ❑ UnkS ❑ UnK6 C Other(electronl4lbta/maps) <br /> FILE ADDR <br /> Strati Street Name EHD USE ONLY <br /> 00 <br /> 2. 32 wTGr:� ✓3. tfisey S'roek -0� <br /> 4. G IL..sw 1T,aeY 7b 0KTi�✓ L,1F.11(l) <br /> 6. G /:Er.A7lM STiceT >P e- <br /> r/ V ) 1 V <br /> 6. 0 <br /> 7. <br /> B, <br /> 9. <br /> 10. <br /> Spectfic Date Range of Information Requested: From 7 9 o to _ r /'G Is..r <br /> AUNDERGROUND <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 73HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHIDLE <br /> OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY ❑WASTE TIRE <br /> TANK(MC ITORNG/REMOVAL) ❑DOC KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED PIERCING <br /> FACILITY ❑MOTELMOTEL ❑PUMPER TRUCK(YARDICHEM TOILETS <br /> ❑MEDICAL WASODY PIERCING ❑POIX/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILRY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY;RIDAY 8G AM-6:00m - <br /> ExCLDLANG HOLIDAYa. <br /> 1. List up to ten addresses in the space above. Select the type(S) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-tor additional assistance with file addrpsaps rn ef�r� <br /> the EHD- Annlir�H....� .e.......,..� _..__....... _. ... . <br /> F�y1� <br /> 0 <br /> el requmW-p <br />