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I� <br /> ! <br /> ATE R D HD LOG NUMBER <br /> I ■ RECEIVED SA JOAQUIN COUNTY <br /> ■ ENVIRONMENTAL HEALTH DEPARTMENT <br /> li AR � 1868 East Haze on Avenue, Stockton, CA 95205-$232 <br /> g 2nn14 <br /> 2 <br /> Telepholne,• (209) 46.8-342 .Fax: (209)461-01.38 Web- www.sjgov,org/ehd <br /> ENVIRONMENTAL HE&TH <br /> PEMIT(SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �" II � lTr✓t Eli BUSINESS/AGENCY:. E13 IIV't�.G i. IUCD <br /> A00f _ r l;�F U 71U E- CfTYISTATEIZiP: <br /> PHONE-(I): SlL�)9l��JCf�I PHO E(2):� hen Qb�c 419ACSlM3LE: -7?) `1 lTENTATIVE'rAPP01NTMENT DATE: Time: <br /> (Please allow 10 business days from 4ate 6f application submiFta)--reomttve only-must be conflntred) <br /> CHECK BOX TO EXPEDITFE REQUEST-$125 FEE(CA$H OR CHECK ONLY)-REOLIES'T PROCESSED IN 3 BUSINESS DAYS <br /> SIGN TUBE OF APPL1CAMT f2 - OAT£ �L <br /> f4ectror,is Into.rmadon-. []List 0 Map— cript)on. <br /> ELLE ADDRESS EHD USE ONLY <br /> trcet# Street Name COY ElU 1 <br /> i AD tZ �2r <br /> 3:3 <br /> 4- <br /> ACL A IUC,� 1� l�kJ `/ �unit 2 <br /> 4- ,j Unit 3 <br /> F <br /> k5 'M <br /> unit4 <br /> El Ur*v <br /> Q units Range of tnfionnation Requested- From to � <br /> E-NVIRONME NTAL HEALTH•DEPAR ENT 1FfiEs <br /> IIHAZAFM <br /> D TANK tUST)CLEANUP-SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE'FArit NEH LE <br /> -OTHER LEANUP�(NON-LOP) HOLISM ABATEMENT ®WASTE TRE 3 fi �s fp/ �i J f� <br /> UNDER D TANK(MONrrORINWREMOVAL)J, FOOD FAM-ITY ❑DAIRY <br /> � TANK O icym#�Aa1C,4/DOG Keff& • �WASTEWATER TREATMENT PLANT <br /> . <br /> QS WASTEMA?ARDOUS{MATERIALS 9� MOTF-LIHOTEL ❑PUMPER TRUCKIXARDICHEMICAL TOILETS <br /> TIEREDRMriTtDFACILJTY POOL/SPA ❑LAND USE APPLICATION SifES <br /> TATTOO/bDY PIERCiN© Cf3MKAINT RESPONSE'RECORDS ❑OrMER(PLEASE SPECIE°() <br /> WELL At D SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1_ Li to ten sddre_*. a_ In the space above. Select the type(s)of files from the list above by checldnq,�e appropriate <br /> box(e )_ At least one.file type MUST be ssiecte . Fax to(20 464.0138 or malt to the address indicated above. Address <br /> range will not be accepted-for additional assl tante with file addresses,contact the EHE). Application—T s received after <br /> $:00 p will be processed the next buslpess da . <br /> 2.. The E D will,notify the.applicant if any EHD fil exist, An appointment for review will be confirmed approximately ten(10) <br /> days er receipt of application. The files will held for a maximum of five business days for review. Appointments <br /> shout be scheduled accordingly. <br /> .3. A file. iat is actively being worked on by EMO stRiff may not be Immediately availabis for review. A new application may be <br /> submi ted when the file is available. <br /> 4. Any fi not returned In'the same.condition.as reloased an%n.11.,be.reorganized by EMD staff at.the expense of the applicant, <br /> Future file.reviews by the same applicant may.re quire a$125 deposit prior to review. "'BOXED AREA-EHD USE ONLY <br /> U Reco s proVided by Staff-PPR Comp'lete,Staff Name. <br /> Rece i ved Time-Mar, 20. `'2014` 1 ; 15PM—No, 5503 91°"a <br />