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10/20/20 4� a6a01�© <br /> ENVIRONMENTAL <br /> U ! ll1�� � SAN JOAQM Cam PAGE 01 <br /> ENvMGIVI RNTAL HEALTH REPARTMMNT <br /> _U 304 East Weber Avenue, 3'"Floor, Stockton,CA 95202.274 <br /> Telephone,(209)468-3420 Fax:(209)464-0138 Web:wvvvv.s ov <br /> PUBLIC RECORDS RELEASE APPLICA.UON <br /> APPLICANT: IrVi 1L G) gUSINESSIAGENGY: .(_CPY1,S�l � N, <br /> ADORES$; Q1S17 ) il'�C� f /� <br /> PHONE(1): 21 -SPC �7 i PHONE(2): 14 ri) q L4 0-Z <br /> TENTATIVE**APPOINTMEh1T DATE: Time: <br /> (Please Allow 10 businass days from date of app-FIc tion submittal-•Tentative only.must be contlrmed) <br /> CHI-CK BQX TO EXPEDrra REQU $T-49 l~E(CASH OR CHECK ONLY)-IRI:QUEST IFMCESSED IN 9 OUSINES5 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Infonnatiort, List Ej Map--Descr)ption: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Name City Unl(1 <br /> an pan ren s �K� eJ i <br /> Z. M+ Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> 6. Unit 4 <br /> 7. /\ <br /> Unit <br /> 9, I <br /> 10. Unit 8 <br /> Specific DatA Mange of Informatlah Re,questsd.From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIL.f S <br /> UNoeRcROUNn TAW(US Q CLWUP SnT,(LOP) M I]Qvgma ASATrjwSHT Was 7z FAcwTyft* Le /U6 <br /> l� GLFAtdUP SITE(NON4.0p) �C1700R FACILITY <br /> UNAF.ftGAtiUNn TANK(M 0 WOR NWREM 0VAL) 0 Doc ISWNEL AIRY <br /> 13:l K4zw¢naus WAZTe GENEXATau ❑GarxeN RANcN A:TCWATM TMATMENT PLW' <br /> d TIERED PIERiaMM TACtLM Q Mo7rdJlclan —4kPVMPER TRU MNAIaDXNE M TOLLM <br /> Q 7Ar=1B0DY PIPRMNG ❑POQLJSPA -bdANo UsE APPLICATION SMS <br /> MEDICAL WAST»FACILITY C3 OTHER(PLEASa SPL'cIFY) _ <br /> WELL AND SEPTIC PERMIT RFGOkCSARP AVAILAULS FOR REVWW • MONDAY-FRIDAY 8:00 AM4:00PM • FXCLUIDN(;HC,UWAVS- <br /> 1. flat up to ten addmssas In the space above, Salect the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file typo MUST ba selected, Pax to(209)484.x138 or mail to the address I(Lftatod above, Address <br /> ranges will not be at capted -for eddltional assistance with filo addresses,confact the EHD.Applications racelved after <br /> 3:00 pm will be processad the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ton(10) <br /> days after recelpt of appllaatlon. The files wlll be held for a maximum of five business days for revlew. Appolntmonts <br /> should be scheduled accnrdingly. <br /> 3, A file that Is actively being worked on by EHD staff may not be Immediately available far review. A new application may be <br /> submlttedwhen the file is available. <br /> 4. Any file not returned In tho same condition as released will be reorganized by EHD staff at the expluse of the upplieant. <br /> Future file reviews by the sante applicant may require 4$95.00 deposit prior to review... <br /> EHp USE ONLY <br /> -o <br /> I0/10 39vd S1Nvi-inSN00 ISd 66099bLSZ6 Sb:ZT 81902//-T/0Z <br />