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09/14)20 5 :09 FAX 9162905429 WKASENVIRONMENTAL U002/002 <br />0 <br />V� <br />DA � 1 EHD LOG NUMBER <br />II V �d SAN JOAQUIN COUNTY <br />5d 2005 ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 jqy5o ENVIRONMENT HEALWephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/chd <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />UU51NESS/AGENCY: [^f4'14 Oa —XC 0%1 Q ASSo C. <br />ADDRESS: 3050 =ft f. S4r•'4 f bar✓D I t-", -S f .$-e ../e,..._ % C^ 9r6 4/ <br />PHONE (1): 9/6 - 3 :7 2- - /44 3 V PHONE (2): FACSIMILE: 0/4�- - 2 7G - .s4/2 e? <br />TENTATIVE' APPOINTMENT DATE: 9. m. O S' Tlme: ORAft„ <br />O 0 w <br />Axil <br />(Please allow 10 business days from date of application submittal - •Tentadve only - must be Corti <br />El CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 B <br />=W044 Z., <br />SIGNATURE OF APPLICANTDATE %�/S/%n�Cam <br />— <br />UNIT DISTRIBUTION <br />❑ unit 1 ❑Un Un k <br />nit4 ❑ Unit 6 ❑ Unit C <br />Other(electronicillstatmaps) <br />FILE ADDR <br />EMD USE ONLY <br />Streetf Street Name city <br />1. 00�uf. <br />?vee 7- <br />S-ro G %cr• <br />2. 32 <br />wwr:c A✓ t*4I!7- <br />S7eckre�✓ <br />K ri.✓ F <br />4. <br />Ci <br />� <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. - <br />Specmc Date Range of Information Requested: From / J 9 o to F. -e- Sa r <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 13 HOUSING ABATEMENT 13 SOLID WASTE FAGLRYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) El FOOD FACILITY 11 WASTE TIRE <br />UNDERGROUND TANK (MMW <br />OTONGMEMOVAL) ❑l)aG KENNEL ❑DAIRY <br />C3 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED PIERFArACING <br />❑ MOTEU140ML ❑ PUMPER TRUCKWARDICHEM TOILETS <br />❑ MEDICAL <br />WASBooy E FACILG ❑ PDOUSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WA9TE FACK.T' ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 4640138 or mail to the address <br />Indicated above. Address ranges will not be accepted -for additional assistance with file addras_%m rnntor+ <br />the EHD. Annlir.fin..e .e..,,I.....a _n__......... .. ... . <br />