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DA 117 RECEIVED g® / p-� EHD LOG NUMBER <br /> RECEIVED V ED EN O MEiCOUNTY JOAQUIN <br /> NTAL HEALTH DEPARTMOT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> NOV 10 ZI)gelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /W/M, IBUSINESSIAGENCY: <br /> ADDRESS: �y�cy ��ays.olr �o.� �yFf CITYISTATE/ZIP: S/y�Ey�n <br /> PHONE (1): o7v� S�iSs-n33> PHONE (2):o��>- y7s-Swq 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 <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> ue uq <br /> 2. es .D nit2 <br /> 4. <br /> Unit 3 <br /> (jt"ZzrJ <br /> 6. <br /> _ _ nit4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4 DERGROUND TANK(UST)CLEANUP SITE(LOP) F-1HOUSINGABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> I���OTHER CLEANUP SITE(NON-LOP) F1FOOD FACILITY E]WASTE TIRE <br /> L.7 J OERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑AIRY <br /> 66 AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> 21TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POCUSPA ❑LAND USE APPLICATION SITES <br /> f1 Been 14 -- r'.COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> Wes Widmer FOR 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 /> 9` CA License No.01315686 ice with file addresses,contact the EHD. Applications received after <br /> V3439 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 /> OR +1 209 475 5109 <br /> Moe +1 209 598 0331 <br /> 5102 a not be immediate) available for review. A new application and be <br /> FAX *1 209 475 5102 Y Y PP � Y <br /> EMAIL wesmidmerecolliers.corn <br /> www.colliers.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 48-06 Will <br />