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DATE RRFFC(E'IIVVED ( JOAQUIN COUNTY EHD LOG NUMBER <br /> RECEIVE[ ENVIRONMENTAL HEALTH DEPARTMENT <br /> EM NT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> NOV 10 20}} <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd ' <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: gs /;?/ 4USINESS/AGENCY: <br /> ADDRESS: CITYISTATE/ZIP: <br /> PHONE (1): p7pJ SiSS_o33/ PHONE (2):a�ry-�7S-Siolj FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE Time: <br /> (Please allow 10 business days from date of application submittal-'1"entafive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST E'CAW OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l// e DATE iiZ'���/ <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 111��J Street 9 Street Name city Unit 1 <br /> 2. <br /> It <br /> 4. L, �I <br /> -- - - / Unit 3 <br /> 5. <br /> 6• <br /> nit 4 <br /> 7. <br /> S. - <br /> _. _ ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to \ <br /> ENVIRONMENTAL EALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> 11tlOTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY El WASTE TIRE r_/�1 t���� <br /> LTJ DERGROUND TANK(MONITORING/REMOVAL El DOG KENNEL El wl� V <br /> RDOUS WASTE GENERATOR F-1CHICKENRANCH WASTEWATER TREATMENT PLANT <br /> hd IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> Wes Widmer OR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Vice President t the type(s)of flies from the list above by checking the appropriate <br /> In us r al Properties ax to 209 464-0138 or mail to the address indicated above. Address <br /> CA License No.01315686 ice with file addresses,contact the EHD. Applications received after <br /> 3439 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 /> DiR +1 209 475 5109 <br /> Moe +1209 598 0331 <br /> FAX .1209 475 5102 may not be immediately available for review. A new application may be <br /> EMAIL wes.widmerecolliersmm <br /> .W.oulllers.com Bed will be reorganized by EHD staff at the expense of the applicant. <br /> re a$125 deposit prior to review. <br /> I' i / 122 7X WA 5112/21 <br /> t s14A e <br /> ( i - ' <br /> EH <br /> 8/1/11 <br />