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DATE RECEIVED 4§ EHD LOG NUMBER <br /> SAN .9OAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV j 2�1} 600 East Main St. Stockton, CA 95202-3029 l8 <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd RK <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �5 ,�%1gUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> 5i Dc f �'r <br /> PHONE (1): a7v% S�Sl-o331 <br /> PHONE (2):uV9- H7S- iv y 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 REQUESTEE(CAW OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l/% DATE //0 4,� <br /> Electronic Information: ❑ List ❑ Map– Description: <br /> FILE ADDRESS EHD USE ONLY <br /> —Street# — Street Name – City _ ❑ Unit 1 <br /> tw_ <br /> 2 — - <br /> �rt (1�., y� <br /> nos - _ �>7 � Kl [+rs' l� nit <br /> 4. <br /> 5. <br /> 6. <br /> nit 4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> Ll Unit 1 <br /> Specific Date Range of Information Requested: Fromto ' <br /> ENVIRONMENTAL 9EAAaLTH DEPARTMENT FILES <br /> �3DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT []SOLID WASTE FACILITYNEHICLE <br /> �� HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE ('�/�'1t���� <br /> 2`Q DERGROUND TANK(MONITORINGIREMOVALN ❑DOG KENNEL ❑9AIRY )'V 11 \V <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH LO WASTEWATER TREATMENT PLANT <br /> O'TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> n "" COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> Wes Widmer OR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Vice President t the type(s)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.01315616 ice with file addresses,contact the EHD. Applications received after <br /> 3439 Brookside Road,site 101 st. An appointment for review will be confirmed approximate) (ten 10 <br /> Stockton,CA 95219 Id for a maximum of five business days for review. Appointments ) <br /> i <br /> Die .1209 475 5109 <br /> Moe +1 209 598 0331 <br /> Fax +1 209 475 5102 nay not be immediately available for review. A new application may be <br /> EMAIL wes.widmer(dcolliers.com <br /> www.colliersxom ed will be reorganized by EHD staff at the expense of the applicant. <br /> re a$125 deposit prior to review. <br /> 1' e r <br /> I I' s (0 115 P <br /> EH 4 . <br /> 8/1171 <br />