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09/14!20 5 0:09 FAX 916290542 WKA*ENVIRONMENTAL Z002/002 <br /> © <br /> DA 1 / <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 d 2005 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> ENVIRONN?ENT HEALToephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg,ov.org/ehd lqy5o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTM R I4-,k C.✓ BUSINESS/AGENCY: W4!J4 C,- <br /> -Iry ti J A SSoC. <br /> ADDRESS: 3oJ�O Z-..r�Se< D�'v-b f,✓cs S< �4�"+- 7;;ter^^ <br /> PHONE(1): 3 7Z Z - 9 S-6 4 <br /> T PHONE(2): FACSIMILE: 9�G -..Z 'Io � -5-q2 9 <br /> TENTATIVE' APPOINTMENT DATE: '9- /9• o S� Oho v <br /> (Please allow 10 business days from date of applicatlon submittal-"Tentative Only-m <br /> ust be CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE —'711,110 �— <br /> UNIT DISTRIBUTION D Unit 1 D Unk 2. Unit <br /> nit 4 Unit 5 Q Unit 6 C Other(electron"Ists/maps) <br /> FILE ADDRESS <br /> Street# Street Name cl1. EHD USE ONLY <br /> 2. 32 0 1, •c 7- sTo C k <br /> 3. ww r.'c. �✓ Tr t c 7- S"Te c k 7' d✓ 1 �C- <br /> C4 "-C.-04M S?-e.C. Ta cf- —4. <br /> , l <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From _ ( °l q o <br /> tot- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) D SOLID WASTE FAGLITYNEHICLE <br /> UNDERGROUND TANK(MGNToFmNG/REMOVAL) D DOG KENNELTM 0 WASTE TIRE <br /> D HAZARDOUS WASTE GENERATOR DAIRY <br /> D TIERED PERMITTED FACILITY D CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> D TATTOWBODY PIERCING 0 MOTEUHOTEL 0 PUMPER TRUCK(YARDICHEM TOILETS <br /> 0 MEDICAL WASTE FACILITY D POOUSPA 0 LAND USI=APPLICATION SITES <br /> C3 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <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 (2091464-0138 or mail to the address <br /> thindicated above. Address ranges will not be accepted-for additional assistance with file address,•c r nnr��r <br /> e EHD. Anniir Attnnc ...., _c.__ ....,. <br />