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UA IE RECEIVED + EHD LOG NUMBER <br /> RECEI Q✓gg® � ENS O MEtCOUNTY jOAQUIN <br /> NTAL HEALTH DEPARTAT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> NOV 10 Z*elephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: es 4 /��BUSINESS/AGENCY: <br /> ADDRESS: �Hzcy � �s��,�t Q, lad/per CITY/STATE/ZIP: <br /> PHONE (1): o7yJ- S�iSl-o33/ PHONE (2):o�%- q7S-S„�c> 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 OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ///0/// <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name _ City ❑ Unit 1 <br /> / ZZ nom[C. NTT G <br /> 2' .Veif_&- Z�S t_ _ ,EY�>7 _ -�Jnit 2 <br /> 3. -7� v� t4F e (� <br /> 4. �f_ Unit 3 <br /> 6. <br /> nit 4 <br /> 7. <br /> 8. <br /> El Unit 5 <br /> 9. <br /> 10. <br /> [:1 Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT E]SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY E]WASTE TIRE <br /> MDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑9AIRY <br /> AZARDOUS WASTE GENERATOR E]CHICKEN RANCH ©'WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> f-I n4r•n1c 1 c -- '�COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> Wes Widmer OR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Vice President t the type(s)of files from the list above by checking the appropriate <br /> Industrial Properties :ax t0 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 N 209 475 5109 <br /> MOB +1 209 598 0331 <br /> `Ax .1209 475 5102 nay not be immediately available for review. A new application may be <br /> EMAIL wes widmer(dcolliers.corn <br /> www.coltiers.com ed will be reorganized by EHD staff at the expense of the applicant. <br /> re a $125 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 6ryryf <br />