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09/142015 0:09 FAX 916290542- WKA*ENVIRONMENTAL R002/002 <br /> DA <br /> SAN JOAQUIN COUNTY END LOG NUMBER <br /> 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 14 2005 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> ENVIRONMENT HEALTO!"phone: (209)468-3420 Fax:(209)464-0138 Web: ww,W.sjgOv,org/chd IqF5o <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTIM0. +-II­k , '7'; <br /> BUSINESSIAG <br /> ADDRESS: 3050 IENCY- W4 04 C,_ A rr.c. <br /> -s-, ,,- )'o-.4- C.1. 2S-4 f <br /> PHONE(1): 2- - 14Z 2(1 _PHONE(2): <br /> TENTATIVE*APPOINTMENT DATE: 0 '910 <br /> FACSIMILE: (- -.2 791 <br /> Time: '010 0 <br /> (Please allow 10 business days from dateof application Submittal-*Tan(atiVe only-tnu-st-be�conflm*d) <br /> CHECK BOX TO EXPEDITE REQUEST b$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT — I DATE. <br /> UNIT DISTRIBUTION 13 Unit I M Unit 2. Unit nit <br /> Other(eIeCtronIc/ftWnm)aps) <br /> FILE Anr%0=t-r <br /> street# Street Name city EMD USE ONLY <br /> 0 W 7- '9'7- <br /> 2. 3 Z & en k ro <br /> .5*-ro C k 7-0 0­' oi-)2 4) <br /> e,7, rp C;1<ro, <br /> 4. 6:&Vr- S-7r'ewr <br /> 6. -Sf_rwe_ k, <br /> 6. <br /> 7. <br /> 9. <br /> U0. <br /> Specific Date Range of Information Requested:From it 7 <br /> to Xv- r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 173 <br /> OTHER CLEANUP SITE NON-LOP( HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> ) 0 FOOD FAcIu <br /> UNDERGROUND TANK(MONITOMNGIREMOVAL) 0 DOG KENNEL <br /> E3 WASTE TIRE <br /> E3 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 DAIRY <br /> 0 TIERED PERMITTED FACILITY 0 WASTEWATER TREATMENT PLANT <br /> 171 TATTOO/BODY PIERCING0 MOTELIHOTEL E3 PUMPERTPUCKIYARDICHEM TOILETS <br /> rl MEDICAL WASTE FACILITY 0 POOLMSPA 13 LAND USI-_APPLICATION SITES <br /> 0 OTHER(PLEASE SPECIFY)_. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-S:WM - EXCLUDING HOLIDAYS. <br /> 1. List UP to ten addresses in t I---------- <br /> he space above. Select the type(s)of files from <br /> appropriate box(es). At least one file type MUST be selected. the list above by checking the <br /> Indicated above. Address Fax to or mail to the address <br /> ranges will not be accepted-for additional assistance with <br /> the EH16._Ann1it-A+i^n& e address . rnnfnpf <br />