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III Oct 14 2014 8: RGAM THF UPS STORE 2503 91-'351772 P• 1 <br /> j■ EHD LOO NUMBER <br /> 1q0 ��� � SAN JOAQUIN COUNTY ,GO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 14 2014 1868 East Hazelton Avenue, Stockton, CA 95206-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.Sjgov.orgland <br /> IEWRONMENTALHEALT <br /> o fH PUBLIC RECORDS RELEASE APPLICATION <br /> RMITMFRIfln <br /> APPLICANT: 1 I / r1/ �f`�l / 6USINESSIAGENCY: <br /> ADDRESS: 1057,5-�__ c a�`� ��` x�_ CITYISTATEJZIP:__GG <br /> PHONE (1): �roGG PHGNE(2): FACSIMILE: e ;3 `O-c';& `IOC- <br /> TENT TiVE`APPOINTMENT DATE: Time: <br /> m <br /> (Plaaaa allow 10 business days frotpp1 <br /> o a1 on submittal--TwtaNv*only-must b*con <br /> ❑ raw- <br /> CHF=CK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Irrfartnaticn: ❑List❑ Map-DeSCIVIl on: <br /> FILE ADDRESS --f-fild W e Q L <br /> S.heati Stmtt Nam* City 0 unit <br /> 2. S �{ 6 ,.(�— V ../, D,-t) Sf t ( 3i=11cy UrA2 <br /> 3. 1 Rejw I l i <br /> 4. ltNt 3 <br /> e. <br /> unit4 <br /> T. <br /> 80 unit 5 <br /> 9.' <br /> 10. Unit 6 <br /> SpocMc Dais RwW of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILL <br /> NDERGROUID TAIK(LIST)CLEANUP SITE(LOP) Q IIIIII WASTE FACILITY 1771 SUM WASTE FACIMNEHICLE <br /> OTHER CLEANUP SITE(NDN•LOP) ❑HGUBM ABATEMENT ❑WASTE TIRE <br /> IDERGPDu D TANK(MoNrroRwGfREMOVAL) ❑F00o FACILITY [j DAIRY <br /> YI SRDtND TANK ❑CMCXIEII RMC14 DOG KENNEL F-1 WA6TMTER TREATMENT PLANT <br /> UYAZAIMOUSWASITIHAZARDOUSIVIATERIALS ❑U0n1jHoTEL ❑PUMPERTRUCKNARD)CHEWALTOI Erb <br /> TIERED PERMITTED FACILTY ❑PDOUSPA ❑LAND WE APPLICATION 9n E8 <br /> ❑TATTOD&W PIERCING C0NPIJUNr)RE8P0WREC0RD9 El OTHER(PLEASE SMFI <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIL LE Fof2 REvilm MONDAY-FRIDAY 9:00 AM$:00PM(EXCLUOINO HOLIDAY$) <br /> 1. List uo4Q_f8(r ad�rsas*e In the apace above. Select the type(&)of flies horn the list above by checking the approptteaa <br /> box(ea). At least one file type MUST be aakwila& or mall to the addMgp.Indicated abom Ad r an <br /> ranges will not be accepted-for add Itlolel assistance with ilia address.contact the EHD. Applications racelved rfber <br /> 3:00 pm will be processed the next business day. <br /> 2, The EHD will notify the applicant N any EHD f41ea exist An appdn6nent for review will be conflrmad approxlmabaly ben(10) <br /> days after receipt of application. The flies will behold for a mmdmum offlve business days for review- Appointments <br /> should be scheduled accordingly, <br /> 3. A We Urate actively being worked on by EHD staff may not be hnmedlataty available for review. A new apptleatbon may ba <br /> submitted when the file Is available. - <br /> 4. Any Me not returned in the same condition as released VAR be reorganised by EHD staff at the expense of the ap Beard. <br /> Future rte reviews by the same applicant may require a$125 deposit prior to review. <br /> > r <br /> q. <br /> " r <br /> . ) byInti('/`P,,f}�',` GOYtI@}@' StIfP.tMd1�(p <br /> trro�sw <br /> Received Time 0ct. 14. 2014 9 : 34AM No. 7324 <br />