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104/15/2014 13:06 FAX 3106154. 4 U001/001 <br />.1 <br />DATE Ri;CENEO � �� <br />I . EsHf) L06 NUMBER <br />ME SAN JOAQUIN COUNTY <br />D ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-8232 <br />APR 0114iephone; (209)'468-3420 Fax; (209) 464-0138 Web: www.sjgov.org/ehd r$ <br />ENVIFIUNMEN: A HEALTH PUBLIC RECORDS RELEASE. APPLICATION d <br />APPLICANT' BUSINESS/AGENCY: PMa:MP_P_ <br />ADDRESS: CITYISTATEOP: Qkzv 12' f _" s A I ?� <br />PHONE (1): - [?SS PHONE (2): FACSIMILE: -5-5_ <br />TEN 7l /VE` APPOINTMENT DATE: t-( (2� Time: ® _ <br />lease allow 10 buslnew days fmm ddttdf application submittal - =Tantsflve only - must be carlfirmad) <br />❑ CHEB )XTO EXPEDITE REQUEST -$125 FEE (CASH OR ghqCK ONLY) - REQUEST PROCESSED IN 3 BQJSINPS DAYS <br />SIGNATURE o APPLICANT ®ATE f f I <br />Electronic InfRj anon: ❑ List ❑ Map — Description: <br />Lpi <br />FILE ADDRESS <br />EHD USE ONLY <br />_ Unit 1 <br />Street Street Name Clay <br />l' °c c to . <br />tki <br />2. <br />�7W <br />51: Q•co Unit 3 <br />r4. <br />nit 4 <br />0 Uhlt 5 <br />9. <br />. <br />r Units• <br />10. <br />Specific Date. <br />UNDL-RGROUND T) <br />of liER CLEANUP; I <br />kUNDvEeRouxo <br />ERGROUNDF,l <br />1 <br />R[W-ARDOUS WA; <br />TIERED PE m n#, <br />TATToo1BWY P'1 <br />WELL AND SEP; <br />1. List Lip to kd <br />box(es). At <br />ranges will ril <br />3:00 pm will I <br />2. The EHD will <br />days after re+ <br />should be se <br />S. A file that is <br />submitted,A <br />4. Any file not <br />Future file r <br />Received Time <br />�3 <br />F Information Requested: From ,To <br />ENVIRONMENTAL HEALTH DEPARTME FiLES <br />MEDICAL WASTE FACiLrnr $OLID WASTE FACp IfYNEHICLE ' �' 11 e� <br />(USI) CLEANUP Sire. (LOP) ❑ /) � <br />(NON -LOP) ❑ HOUsiNe ABATEMENT WASTE TIRE <br />(MONn=NGIREMOVAL) ❑ FOOD FACM MDAIRY <br />CHICKEN R1WCH1 DOG KENNEL ❑ WASTEWATER TREATMENT PLANT %V <br />4AZMOUS MATERIALS ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEMICAi.TOLETS <br />w1uTy ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />NG 7CONFLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECtiY) <br />PERMIT RECORDS ARE AYAJLABLL FOR REVit_Yv: MONDAY FRIDAY 8:00 AM�:OOPM (EXCLUD[NG HOLIDAYS) <br />Tresses in the space above. Select the types) of files from the llst above by checking the appropriate <br />one file type MUST be selected. Faxto (208) 464-0138 or mail to the address indicated above Address <br />D accepted -for additional assistance with file addresses, contact the EHD. Applications received after <br />rocessed the next business day. <br />ifythe applica/rt if any EHD files exist. An appointment for review w111 be confirmed approldmately ten (10) <br />t of application, The files will be held for a maximum of five business days for review. Appalntments <br />uledaccotdingly. ��..Cj./1��J;Letj cy}�ilccUii ccr�t� �� i��<-z�riC 1� ov ri�r�cFu; zt}ir`1.j� Ef <br />rely being worked on by I <br />the file is available. c �?►v1 �I��'' lis} rcSr 72 NurNdbGerL,t r X-40Tn:/5r /l,A/aiun� brz j <br />ned (n the some conditio t'�Ig d i res , CixLc.KS Autfl Rep�LL- 1 .-D rT�t cnd_ fr ve, Nlu,ic4;1oll 'T1as�% J <br />vs by the same applicant KcLra`fhc/7 Nla:kr 3-ach, MkF�)fr ?�L,, r Nt. r(« �<r'1/ t1 -pe -f- �,�to� crit k� y <br />(; *� a,,� a ,r, I,'s �r,<➢ uR"":: '—viCil t,ZdIlflt-5 L�/ i5pmq-On k% ilwers, o12AlorOL,Cal �� `P-cl'l-cnY-cC1114's <br />4-S x '� �v :;=' of �rc�.KfL,? 7i c►7n/r. !?1tY C2ii. —, C C'G6I`6 "1-04 77DI l.l.fl <br />c.-�; •��:,�::;x•.�:•�y �'':�ha.'rk=l r.j&C.5104: Is it) tf-u:. 4=ifr, {?-aJtcltui COP`/ c' <br />tea. .-_._ _-`r-r :• �I Pt %Ct( 1 , 77_C• i 2fJIf2fE! (�lUYll Ci� Cz C�rr- i71lJLG <br />x:r�• s; «ac;•ai�;et;:drs: L4 - 1I Hca (211 e.- y "?7�1 ia.l�'t G` i�u,- �7 ttc�. d QST Jf75trar1. aVq op <br />L'�r�1Q1 (��"C>�id:`� <br />p r. 15. 2014 1:16PM No. 5793 -7�l drn,Jier- 6-) -G2. ►��,� <br />