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DATE RECEIVED EHD LOG NUMBER <br /> �✓ SAN .IOAQUIN COUNTY ,� <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> NOV 10 201}elephone: (209) 468-3420 Fax: (209) 464-0138 Web: wv✓w.sjgov.org/ehd ' <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: gc� 1,�w $USINESSIAGENCY: <br /> ADDRESS: �H3q fS�ao�s.<-G �c < /�/yS� CITY/STATE/ZIP: <br /> PHONE (1): a7y� S�55f-O33/ PHONE FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) - <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$12 EE(CA§M OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name - - _ City <br /> �`',�,� � ❑ Unit 1 <br /> 2' (nititC2� <br /> 4. _ � ; L<n N a <br /> 5. <br /> s- g4nit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to \e� <br /> ENVIRONMENTAL EALTH DEPARTMENT FILES "./ <br /> �����DE <br /> RGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT E]SOLID WASTE FACILITYNEHICLE 0. <br /> �QTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE (�(.9p <br /> KU DERGROUND TANK(MONIiORINGIREMOVAL6( ❑DOG KENNEL ❑1PA 1v�V <br /> LedljAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 17 Ucoicai Mle¢r - COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> Wes Widmer OR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Vice President t the types)of files from the list above by checking the appropriate <br /> Industrial Properties ax to 209 464-0138 or mail to the address Indicated above. Address <br /> CA License No.01315686 ice with file addresses,contact the EHD. Applications received after <br /> 3439 Brookside Road,Suite 108 ist. An appointment for review will be confirmed approximately ten (10) <br /> Stockton.CA 95219 Id for a maximum of five business days for review. Appointments <br /> DIR .1209 475 5109 <br /> Moe .1209 598 0331 <br /> FAX .1209 475 5102 ay not be immediately available for review. A new application may be <br /> [MAIL wes.widmermcollierecom <br /> www.colliersxom ed will be reorganized by EHD staff at the expense of the applicant. <br /> a$125 deposit prior to review. <br /> I_ - -- � r W <br /> ( 5 ;IIj185 _e . <br /> f i - t oL <br /> EH 811N1 <br />