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I <br /> Sep, 4. 2008 3: 18PM No. 0169 P. 2/3 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN c�OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3028 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd 3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; 0 �l(,LIC BUSINESS/AGENCY; �dt/ancCd �nVtY�nnccnau2 ��"�1' <br /> ADDRESS: Z U V [ R pJ/IIAf CitylStatelzip 3 <br /> PHONE(1): LOW- — �}(� PHONE(2): FACSIMILE: <br /> i <br /> TENTATIVE*APPOINTMENT DATE:_ 60kexn6<Yr (I Time: r <br /> (Please allow 11 bueinesa days from date of application Submittal-•Tantativa only-must be confirmed) L <br /> CHECK BOX TO EXPEDITE RE UEST-§103 F C SH OR CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE _ 9/N/2_WW? <br /> Electronic Informatlon: 0 Lis Map-pescrlptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name Cit ` <br /> 1 0 99 n -I-) ❑ Unit 1 <br /> 2 g�I ; 4aa� `unit2 <br /> 3, °I n �'7�J <br /> 4. it <br /> 5. <br /> 6. Unit 4 <br /> 7. ' <br /> S - ❑ Unit 6 <br /> 9, <br /> 10. ❑ Unit6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILLS <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT I7 SOLID WASTE FACILITYIVEHICLE <br /> .OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> 1AUNDERGROUND TANK(MONITORINo1RsmovAL) ❑DOG KENNEL d DAIRY <br /> %HAZARDOUS WA6TE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> M TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 13 TATTOOII30DY PIERCING O POOLISPA ❑LAND USE APPLICATION SITES <br /> r <br />