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2 <br />rk <br />DATE RECEIVED <br />0 <br />0 <br />SAN JOAQUIN COUNTY EMD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT 01 <br />600 East Main Street, Stockton, CA 95202-3029 ,L / <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.$)g400 <br />/ <br />sm""' <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: KIC.g11 /C LJ C7 dN.LLLFl o BUSINESS/AGENCY: GN Vt`o <br />ADDRESS _58 add, N W llM TtL2 Clty/state/zip <br />PHONE (1); Ltr'a--•y Gay o aQ PHONE (2); 'L64. 2 ( 2 6 b f FACSIMIL <br />pE: 9Ad -a }yea <br />TENTATIVE` APPOINTMENT DATE; (Z- a-0 Time: RIO <br />(Please allow 10 buslM ISS days from data a plication submittal. "Tentatlm Only - must 4e confirmed) <br />4 CHECK BOX TO EXPEDITE REQU $105 F C HO ECK ONLY)- REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE Z I% --O <br />11 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City <br />/ <br />1. q tU ah f, k'• I D W ❑ Unit <br />z' <br />1 ( <br />4k Sfoc sf. Rue? <br />Nod ,No to/5 ❑ Unit 2 <br />Z� oUJ 9 <br />3. <br />E o .2 `dJi. <br />4. <br />20 <br />S rS-FoCLCFO At, <br />ll r9 T(Z) of S/NJ f.Lyr7 ',j'h unit 3 <br />s• <br />5`4 <br />�[ <br />5 ,oES /Noco(yQ Unit4 <br />u-iSANDcL'(yP ❑ unit5 <br />, <br />Q Unit6 <br />f� 01.0 1� <br />8• <br />337 <br />114A <br />9• <br />_+ <br />L .Js s , <br />IL 10. <br />Z3 0 <br />�' C1Ll,3�rFa� AIrG <br />�Pcclrrc vara Range or Intormation Requested: From <br />49P? b$ J to prC's2rL>l' <br />JENVIRONMENTAL HEALTH DEPARTMENT FILES <br />.J✓I-UNDERORauNO TANK (UST) CLENT 171ANUP SITE 13 HOUSING ABATEMENT SOLID WASTE FACU-ITYNCHICLS <br />.n OTHER CLEANUP SITE (NON -LOP) r3 FOOD FAciuTY C3 WASTETIRE <br />UNDERGROUND TANK (MONITORINWREMOVAL)a Cl DOG KENNEL d DAIRY <br />�W_HATARDOUS WASTE GENERATORN Cl CHICKEN RANCH <br />C3O NT WASTEWATER TREATMEPLANT <br />TATTOOPBOTELIHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br />L' TATTOO/BOoDYoy PIERCING <br />PERMITTED FACILITY ERCING 0M❑POOUSPA ❑ LANG USE APPLICATION SITES <br />EJ MEDICAL WASTE FACILITY © OTHER (PLEASE SPECIFY) <br />WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8;00 AM.So00PM - EXCLUDING HOUOAYs. <br />1. List up to tan addresses In the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to 209 484.0138 or mall to the address Indicated above. Address <br />ranges will not be accepted —for additional assistance with file addresses, contact the END. Applications received after <br />3:00 pm will be processed the next business day, <br />2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3. A file that is actively being worked on by END staff may not be immediately available for review. A new application may be <br />submitted when the file Is available. <br />4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $105 deposit prior to review. <br />FHn I ASC Mal v <br />a n / /I- I : u �I A / h ". U� �n lI/JhY7•'l/ln4J� <br />_ ! r"'*#D, I <br />QED _ r Y . <br />04108 <br />PUBUO •R <br />TO 39Vd <br />NOdIdO39N3 <br />96LI66960Z TV:TT B00Z/LT/ZT <br />