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04/25/2002 09 :40 FAX a 001/001 <br /> 04/25/2008 69: 43 209d64of ENVIRONMENTAL H -H PACE l <br /> EHDLOG NUM ER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVTRONMENTAL HEALTH DEPARTMEW <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> .i,• Telephone: (209)468-3420 Fax: (209)464-0136 Web:www.a goy.org/ehd <br /> .71 <br /> PUBLIC RECORAS RELEASE APPLICATION <br /> APPLICANT - EUSINESSIAGENCY: �tl['Y"COYI <br /> ADDRESS: 3434 I Yl rcon'I Aue I r v r v e✓c �� A 8'�1 <br /> PHONE(()' a l(E . 460, 07.08 PHONE(2): L4 PACSIMILE: Ila • 1460.OCD®.� <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please aliaw TD business days from date of application submittal-'Tentative only-must Do Oonarmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST.198.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN s AUSINESS DAYS <br /> 21y SIGNATURE OF APPLICANT r, aoDATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name - City ❑ Unit 1 <br /> 1. yay� �IZ�M�iJT 5T R y E) cl'-To <br /> _ p Unk 2 <br /> 2. t}4y 5 f RBMOtJT `DY TOGKTO r� � <br /> U <br /> 3, t} �MONT 6T E: <br /> 4. - <br /> e. unit a <br /> T C] unit c <br /> ts. � N e <br /> Specific Pat* Range of information RaClueated:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Sl(LOP) ❑HOUSING APATEMIll SOLID WA*Te FACILmNENICLE <br /> OTHER CLIIANUPSITE(NON-LOP) I7 FOOD I'Acll 171 WASTE TIRE <br /> tjwolat RDDND TANK(MONRMOVAL) R <br /> OR*IGIREDOG KENNrL ❑ DAIRY <br /> �i{A=AnpeyE WAstt!GENERATaR 0CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> TIERED P5RMITTHO FACILITY 0MOTROHOTEL OPUMPeK T1luCK/YPRDtCNEM TOILETS <br /> 0 TATrOaeODYPIERCING 0 Pool R LAND USS APPLICATION SITES <br /> C]MEDICAL WASTE FACILITY In OTHeR(PLEASE SPECK, <br /> WELL ANP SEPTIC PERMIT RECORD!ARE AvAaAaLE FOR REVIEW - MONDAY-FRIPAY 8:00 AM 5:CDPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of Tiles from the list above by Checking the appropriate <br /> box(ss). At least one file typo MUST be select*d, _IS to(2091 484-01s6 or mail to the addres I�above._ Address <br /> ranges will not be accepted—for additional assistance with Ala addresses,conteM the EHD.Appllaotlons raoolved atter <br /> 3;D0 pm will be processed the next business day. rml rnxiately ten 10m <br /> 4 The EHD will days atter receipit o SPOIostion,the applicantIThaf anyfl es wEHDill be held foles exist. ur as maximunm of fl bvusi will <br /> days for review, APPOlntmants ( ) <br /> should be scheduled accordingly- may not be Immediately available for review. Anew application maybe <br /> 3. A file that Is actively being worked on by EHD staff <br /> submitted when the fila Is available. <br /> 4. Any file not returnod In the same Condition <br /> n a requirel a$ill be deposit b MHDletaff at the expense of the applicant. <br /> Futura file reviews by the same applicant Y <br /> ENO USE ONLY <br /> • ^Ifrou need further assistance please contact Diane Martinez IP (209)468-3425 directly, Thank YOUw <br />