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V0411512014 13:06 FAX 31061546 I�j001/001 <br /> i EHD LOG NUMBER <br /> DATE izEQU ED. SAN JOAQUIN COUNTY <br /> RE <br /> TEN D ENVIRONMENTAL HEALTH DEPARTMENT Q <br /> 1868 East Hazelton Avenue,Stockton, CA 96205-5232 <br /> APR A WLlephoneg (209)468-3420 Fax: (209)4640138 Web:WWw.sjgov.crg/ehd ri <br /> r '\ 17 <br /> ENVIRONMENT A HEALTH PUBLIC RECORDS RELEASE APPLICATION V =' <br /> APPLICANT' BUSINESSIAGENCY;PF!1MF_1? . <br /> ADDRESS: �{(�(A IM � 21 <br /> � CITY!STATEP: t 1�t �'A Fi(7 <br /> PHONE PHONE(2): FACSIMILE: 4' _Sy'9 •b196 <br /> IVE•APPOINTMENT DATE: �� l_4 Time: 0 <br /> lease allow 10 businessfrom days nm of application sulmimal-'7'anl5wve onny•must be ennrlrmad) <br /> ❑CHE XTO ECpEDIT'E REQUEST-$126 FEE(CASH ORC CK ONLY)-REQUEST PROCESSED IN 3 S SIN SDAYS <br /> SIGNATURE APPLICANT DATE. <br /> ct <br /> Eleronlc Infq atlon: ❑ List❑Map-Descriptlon: <br /> OE <br /> FILE ADDRESS EHD use ONLY b "Q <br /> StreetI , Street Name City Unit i` F <br /> 1. N Sr t rr M CDs <br /> 2. -7W I I`a 1 <br /> 3 TO Tb ISI ASr Q 41u1 <br /> 4 <br /> 6 nit 4 <br /> 7. <br /> `I V 1 I unit <br /> B. <br /> JLIU <br /> 1D. � � Unk6• <br /> Specific Date Ran a Informs8on Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES ��rr y <br /> ���vvv������rrrfff(((...UNDERGROUNDi (UST)CLEANUPSITE(LOP) ❑MEnicALWAsmFACILITY SaLIDWAsTEFAc0.RrNEHICue 21 PI)E <br /> OTHER CLEANUP (Nox•LOP) ❑HousHeAEATEMENT WASTETIRE �(pt <br /> UN13E'RGROUNID1' poliffORINGiREMOVAL) ❑FOOD FACILITY DAIRY <br /> ABovEGROuND ❑CRCKENRANCHIDOG KENNEL ❑WASTENATERTRFATMENTPLANT <br /> RIHAZARDOUSWA E OUSMATEIUALS ❑MOTELMOTEL, ❑PdMPERTRUCKIYARNCHmlcALToLrrs <br /> �TIERFD PERM AGILITY ❑PDOLISPA ❑LAND USE APPLMATION SITES <br /> TATTooBDOYPI [NO <br /> �CONPWNTIRESPONSE RECORDS ❑OTHER(PLEASE SPEGtm <br /> WELL ANDS PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-$:OOPM(197tCLUDING HOLIDAYS) <br /> i. List U t In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At a t one'file type MUST be selected. Faxta(208)464&138 er mail to the address indicated above, Address <br /> ranges will rii a accepted-for additional assistance with file addresses,contact the EHD. Applloations received after <br /> 3:00pmwill rocessed'the nextbusiness day. ; <br /> 2. The EHD will tifythe applicant if any EHD files exist An appointment for review will be Confirmed apprmdmately ten(10) <br /> days atter e t of application, The files will be held for a maximum of five business days for review, Appointments <br /> should besc� uledaccerdingly. FE•r).1j• Rt)jj ,1 O-tjiccutf co,,� of i���-i-rit.av o�-�•rTe�jop¢w.ler'SAtI <br /> s: A file that is; Nery being worked on by I <br /> submitted the file Is available. cn2vn Yieo lis+ 4or 72oNw7inr� Gt for Awfo7oysrQufoiune#txetal <br /> 4. file not t mad in the samermnditio Tbi9 0 Tires, cN�•�cks AuFd ue{�a+-� �d i Au.'!cn�f+ve, nlu:.af�:�n masT/ <br /> FutureMae re by the 6=8 applicant Karah'NiT Nlaskr 1ch, 5p+cwCeA46 � <br /> Y,.�rKC a.V2 .Vy,K12k: Sprq an bedl.rxrs LLr—, 5Prcy-c.9 "I'ders op A!cr Cal LLC, spray-en rwll4er' . <br /> - ``' •-K-•-a=to� 9tcckfp/,, Technic �� ��''�• CCDO LI-T1DLj 7761 T.uri <br /> cnpi/ oft Lt 3tia <br /> ;�.. 'l�,V.-z,a;=._:_-,• _ 0000 8 <br /> . . (,rpt �io�) W-- 72-0a Hammer, Pmvtdacl_GD oP fan 1h. 1 <br /> dU ) 1ns{ecQr.CL>N8 <br /> flW4hz <br /> Recce ve+d Time Apr. 15. 2014 1 : 16PM No. 5793 p! it m01203[. G2 <br />