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�w,)/25:"2013 08:55 FAX CT'J, 001/001 <br /> r <br /> ■ EHD LOG NUMBER <br /> 100 DATE RECEIVED <br /> SAN JOAQUIN COUNTY s:"N l;'"` �. ,� <br /> INN.— <br /> BtuF— "E® ENVIRONMENTAL HEALTH DEPARTNI�NT �� F <br /> 2013 1868 East Hazelton Avenue, Stockton, CA 95205`-6232 ✓ ! <br /> OCT 2 5 Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd �f <br /> pOtIMENTAI N PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �Y InPi(aSp p, BUSINESSIAGENCY: F),gr(.Cn <br /> ADDRESS: 1y4yer 0.r fir( 2 CITYISTA7EMP:Qperannonfri CA 9SR{ ri <br /> PHONE (1): PHONE(2): 4((o,g4-0!LOS FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 91/ /2112 Time: <br /> (Please■Ror 10 M»Inese days from mate o epp on subm -" enu e -mwt be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(GSH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 10(2V 1,3 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street• Sten Nome city XA <br /> / eD j Uri <br /> 4. ^ <br /> IJP 5. -IN <br /> 6. 2ux4 <br /> 7. <br /> S. units <br /> 9. <br /> 10. ❑Unit e <br /> Specific Date Range of Information ReWeated: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 7'®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILrrY ❑SOLID WASTE FACILITY/VEHICLE 4 <br /> �y OTH©t CLUNUP Sn(NON-LOP) El HOUSING ABATEMENT ElWAm TRe lj 1 <br /> r'� 32 <br /> UNMRoRouwo TANK(MONrtOMWfftMovAL) ❑FOOD FACUJTT ❑PARY LV�,I <br /> AaovEGRoom TANK ElCHICKBN RANCH/Doc KENNEL ❑WAeTLwATIA TNCATMINT PLANT `I <br /> HA7ARDWf WAaTdHAZARDoua MATeRUUA EjMOTALMMI. ❑PVMPCRTRVCKNARDICHEMICALTOILETS <br /> TIERED PERWI TED FACILITY POOLJSPA E]LAND Use A»ucATm SrTEB <br /> TATTOO/BODY PIERCING Com AR rlRzaPomaE RECORDS []OTHER(PLEASE SPCCUv) <br /> WELL AND SI Liji;01`I le4V1� 12y�r1 ,l15c1lo, /I S"j j" (-;-,-(EXCLUDINGHOLmAYS)- <br /> 1. UZIupto I� la �'� Conplalnt numlxrs <br /> �) A Iolo irC1u5}rtal RP*5101. In t}� File Cnmplanf nuirber dngthe ePPtoPheb <br /> ercU0349D�, 32.z2S, gl'8rlq, agygL re!jole ire Nva tel'_, :abdebove. Address <br /> range s wll ,+» Inwriwri- re+aaf nwn/o r..> XSS-0J70g1 :atlone received erten <br /> 9:DOpmw QrOYidsd a.Ppticanf "� <br /> 2. The END v its 1 -oGH�d, x sJ-Glaa f (c+r )oto ,ndu�,Jrra/, d approxknabyton(10) <br /> days after /)umbers la=3q3, xs3�e�.Il9� x5S-daS�b, xsJ -ua9�7, law. Appointments <br /> shoLlldbe X9r ' 04017, xsJ -o4y01 )'or, 1011 IAdus}r'icd , PcoJidsnt applres✓f <br /> 3. Afile that ,,iIWITrc%dL . eecrel unava ZoAot)dhj letkPu Pr' lot) Inolasyr`icJ kr new application may be <br /> submitted MgreclIon Inc 4 Corn PracludS I nJzrnaJ-Tonal . Prr3JtCLC' 04fIla4& <br /> 4. Any fill nc WI.rn CZ, �b. .q\d1 S. t\trporl, �cr F+w Ile,. Inseofttm applicant. <br /> Future file <br /> 7Re6dirds,, <br /> slam::. <br /> Received Tim <br />