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104/15/2014 13:06 FAX 31061549^' 4001/001 <br /> I " <br /> I� DATE <br /> MC6NED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> REC ED ENVIRONMENTAL HEALTH DEPARTMENT ? 9; <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ` <br /> APR Wilephone3 (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMEN, A H ALTH PUBLIC RECORDS RELEASE.APPLICATION <br /> • i; <br /> APPLICANT, BUSINESSIAGENCY: P Regr1)p- <br /> ADDRESS: CITYISTATEOP: (rl',LNJi c�Q jA(Z� <br /> PHONE(1): ( S PHONE(2): FACSIMILE: Sryo <br /> TENR IVE`APPOINTMENT DATE: LI g 1 Time: <br /> lease allow 10 business days Atom d of application submittal•`7enfatrve only-must be ecMlnned) <br /> ❑CHEC XTO EXPEDITE REQUEST-s126 FEE(CASH OR C CK ONLY)-REQUEST PROCESSED IN 313 SIN S DAYS <br /> SIGNATURE APPLICANT DATE II I <br /> Electronlc Infq eon: ❑List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> ��yy/ <br /> Street# Street Name City Unit rr .KF <br /> cv_ 1. N N'a tP N,r1P o r- +v <br /> ••',ln��,,....�� P (iw ,t Nr2. _ tilf' c1>5 <br /> 3 TOTd 1J Asr �tti HP' yw is - , / <br /> 4. ao y?nswU <br /> � Unita <br /> 4 <br /> Y. <br /> 0 Unit-5 <br /> 9 <br /> 10. Unit e <br /> Spodfie Date Ran a Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE5 ODAIRY <br /> UNDERGROUNDrt (UST)CLEANUP Blit(LOP) ❑MEDICAL WASTE FAcian' SOLID WASTE FACILIIYNEHICLE(7THER CLEANUP (NON•LOP) ❑HOUSINaWTEMENT WASTETIRE <br /> UNOER6RDUND� (MON(="C'IREMOVAL) ❑FOOD FACILM <br /> j��lAwvEGROUND ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT �V"l <br /> tZHA2ARDOUSWA OUB MATERIALS ❑MOTELIMOTEL ❑PUMPER TRUCKIYARD/CHEM=LTOILEfS ` <br /> FloPERPiR'T AGILITY ❑P00LISPA ❑LAND USE APPLICATION STMa <br /> TATTOOBOOY F, R WG ) CONPWNTIRESPON5E RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND$ PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. LisJEHDT41 <br /> In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> bot one�fiile type MUST be selected. Fax to(20 8)464-0138 or mail to the address indicated above. Address <br /> rans accepted-for additional assistance with file addresses,contact the EHD. Applications received alter <br /> 3:0Processed the next business day. <br /> _ 2. Thtifythe applicant if any EHD files exist. An appointmentforreview will he confirmed approximately ten(10) <br /> dat of appllcatlon, The files will be held for a maximum of five business days for review. Appointments <br /> should b-a uled accordingly. / <br /> IY 9 y Ff•17./a, Peas ted ,y3,iicr IF c.,,I( of ice. a, nxn [oI u•Jo: To of <br /> Si A.filethatia', Ne beln workWonb I <br /> submitted w a the flleIsavailable, Gk7' Jia ° lisp 4cr 7Zc> FktrNrlG- LI �Cr A �o oysr 1, !o ivaedL:Jaj <br /> 4. Arry Elle not, t med in the same wnditio _P 0 ares, C.h:kc K'� ALM repuw, -Dd r+LL- /AL' -1 ve, r�Iu:�:Fhop aics�r�r <br /> Future file re 1ws by the same applicant iv,ra-fsw1i Htaskr tzd,, MK4W Tadt, 0,.'F1e+- Tec11, rc i"z,- <br />