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mom <br /> `r o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N 1 2 111 600 East Main Street, Stockton, CA 95202-302.9 / <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: WvrW.Sjgov.org/ehd /�A•g _, <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/A ENCY: <br /> -APPLICANT: e V t 1 t' v% L1 <br /> _ <br /> CItyistaternie L <br /> ADDRESS: <br /> ` FACSIMILE: <br /> PHONE(2): <br /> PHONE(1): > Y Opo ✓' Q <br /> _-__Time:; <br /> TENTA'TtVE+ppppRITMEHT DATE:�L?f�1� ly-moa-, <br /> ' <br /> (Please allow 10 bUSIDBaa days from date of application submittal- Tentenve ont De wn11r*ned) <br /> II ❑ CHECK BOX TO EXPEDITE REOy T-5105 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED IN 313 SINESS DAYS <br /> t <br /> DATE <br /> SIGNATURE OF APPLICANT G <br /> Electronic Information: ❑ List❑Map—Description: <br /> EHD USE O <br /> FILE ADDRESS <br /> seta I street Name I 1 City f O ❑ unftl <br /> [F] UnIt2 <br /> z. <br /> 9E5: r Il <br /> s' <br /> Unita <br /> I X11. <br /> 4. <br /> 5. Unna <br /> 6 I I E3 Units <br /> . <br /> 8. <br /> ❑ Unit fi <br /> 10. <br /> Specific Date Range of Information Requested: From to i <br /> 6 'e, <br /> HEALTH DEPARTMENT FILES L1 <br /> S <br /> CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑soup waste FAcnmNEHICLE'OUI� a <br /> Np17iGROUNO TANK(UST) Cl FOOD FACILITY ❑WASTETIRE <br /> THER CLEANUP SITE(NON-LOP) ❑DOG KENNEL [3➢NRY J_. Z'r <br /> ROUND TANK(MONIToslNOIREMOVAL)01' �CNICKEN RANCH I7 WASTEwATER TREATMENT PLANT MJ <br /> V*jAZARDWS WASTE OENERATO� 0CHICKENRAN 0 PUMPER TRUCKJYARDICHEMTOILETS <br /> TEpEo PERMITTED FACILITY O POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) �p0.V <br /> WELLANDSEpM PERMITRECORDeARE AVJULA13LF FOR REVIEW - MONDAY-FRIDAY B:OO AMS:ODPM - EXCLUDING HOL®AY9• <br /> 1. Lfet up to fon addresses In the opera above. Select the type(s)of files from the list above by checking the appropriate <br /> box(aaj, At levet one Ala type MUST be selected. Fax to IZOtx)4t34013a or mall to the address Ind Icat clitd�hO�`�ed efte s <br /> ragges velli not be accepted—for additional assistance with Ale eddresaoa,contact the EHD. Apel <br /> 3 oo ftrt.mrfl!pa ytgceased the next business day. <br /> art 1µi no"ihy applicant ff any EI-IDfele,Exist. An appolntmentfor review will tea confirm d Rfx)T"n:lnv�ta(y Ran 00i <br /> t, L O't'appilistiAn. The flies avllt ba hold for a maximum of live buellultm day i f�f r> Mil ArPolntm ata <br /> reay tI' . . <br /> ibf �IiD st aif may not be lmmedlatcly avililabl o+o� <br /> gy cr i inn a;$rrrf catcd Mil be rtstarg Itrsd by i f 1D stbfx D*,n'F ,I afar as +t)6sasf <br /> row rnc",a1stlaSl4'he1xL�eittiii(rT4onovtoN. . <br /> nl t <br /> �gf" �- <br />