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'fffo' r' 23 2014 11 : 06F1M THE UPS STORE 2503 9167251772 p. 1 <br /> l <br /> I■REC8 V `: EHD LOO NUMBER <br /> ■ [DATE RECEIVED <br /> ■ SAN .JOAQUIN COUNTY <br /> Xe <br /> OR 2 3 2014 ENVIRONMENTAL- HEALTH DEPARTMENT 1 �. <br /> 1869 East HaziD 0 n a, to .y A 95205-6232 <br /> EWRONMENtAtRMS � � olophvne: (209)468-342 ax: (2t?9)464013$ eb: www.sjgov.org/9hd <br /> PUBLIC RECORDS R APPLICATION <br /> APPUCANT-. ( /�/a ell BUSINESS/AGENCY: <br /> ADDRESS: r G a.- �q �� CITYISTATEIZIP: <br /> - PHONE(1): G (n `7 7 ��6� PHONE (2): 5ct..1. FACSIMILEgt3 .2 <br /> T6' TATIVE"APPOINTMENT DATE: Time: IFO 2 <br /> (Please allow 10 business days from date of application subadital-'Tenn► s only-must be conflrrnvd <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CAPH OR CH CK ONLY)-REQUEST PROCESSED IN 3 USINES DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> Electronla Informatlon: ❑ List❑ Map-Description: <br /> f2VFILE ADDRESS EHD V5 OLY <br /> t3tr+aet S Street Memo //city <.� unit 1 <br /> zy ,r�� f- C ( �s i(1x�t 11" --L°Sp h) Unit 2 <br /> 3. <br /> 4, _ p UnX 3 <br /> 5. <br /> 8. -Untt 4 <br /> 7, <br /> Unit 5 <br /> 8. <br /> 10. Unite <br /> Specific Date IUngs of Information R.qusetad: From ----- to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERu mmo TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACtLrtY ❑ SOLID WAISTS FACUTYNEHIW r1 ), <br /> OTHER CLEANUP SITE(NON-LOP) Houswo AtiATfil w ❑WASTE TIRE 3 <br /> GRWND TANK(MaNIioRINO/REMOvAL) F000 FAcrm ❑DAIRY I �D� 14 <br /> �u . <br /> GROUND TANK CHICKEN WcWDN KENNEL ❑WASTEWATE TREATNENT PLANT 5"I` <br /> HAzARDow WABTE/HAzm=u&MATERIALa S MOTUMOTEL PUMPER TRUCKIYARDICHE19CAL TOILETS <br /> TIERED PtRmTm FACILITY ❑PogJ$PA ❑LABII USE APPLICATION STEB <br /> ❑TATf00BODY PiEftow ❑COWLAIKORESPONSE RECORCe ❑OTHER(PLEASE SPECIFY) <br /> WELL AND Sap=PERMIT RECORDS ARE AVAILABLE FOR REVww; MONDAY-FRIDAY 8:00 Aid-5:00PM(EXCLUDINO HOLIDAYS) <br /> i. Liat un to ten addraraaes in the space above. Seleat the type(s)of filos from the list above by checking the appropriate <br /> box(es� At le"t one file type MUST be selected. Fax to-0091AH&I30 or mail to the address Indicated,above. Address <br /> ronyes Will not be accepted-for additional assistance with tib eddresses,contact the EHD. Applications received after <br /> 3:00 pm wIN bei processed the next business day. <br /> 2. The END will notlfythe applicant It any END flies wrist. An appointment for review will be confirmed approximately ton(10) <br /> days After receipt of application. The tiles will be held for A maximum of five business days for r•avlevre Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by END staff may not be Immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned In the same condk4on as released will be reorganized by EHD staff at the expense of the applicant <br /> Futuro file reviews by the same applicant may require a$125 deposit prior to review. ,t Y <br /> d. <br /> Z. - <br /> itN <br /> b Cw/ -b0 JY J' X <br /> =S `2 S D2 �"� ...XS1'-hZ�( �tSJ:�02"1d � � <br /> 4.00011:2-'1q R11 3 Cor Z%b Gp.(l,(',r#iIC4 rr }S 510 ' <br /> Received Time Apr. 23, 2014 12: 14PM No. 5863 <br />