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RECEIVEq <br /> DATE RECEIVED (-� <br /> SAN.IDAQUJN COUNTY EHQ LOG NUMBER <br /> JUL 0 9 2017 1--0 ENVIRONMENTAL HEALTH DEPARTMENT r,�� <br /> 1888 East Hazelton Avenue.Stockton, CA 95205-6232 VVI <br /> LlJV(f@ONfv!l�IfJAL Fit4J1LTN Teieuhone:(209)4683420 Fax:(209)484-0138 Web:www.sjgov.orgjehd <br /> • PEMAITARf;rjACES Shannon Castagno ASE APPLICATION <br /> 30251 Golden Lantern, Suite#E-305 <br /> APPLICANTt— Laguna Niguel CA.9-1677 _BUSINESSIAGENCY: <br /> ADDRESS: Tel: 949--429-3564 -Fax: 949-429-3563 — CITYISTATEIZIP: <br /> PHONE(1): _ Shannon@EnvironmentalSupportServlCes.Com . FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITER EST-$139/FFE�tE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT t eY1 ( �.tgj10 DATE. L1_2y,1j7 <br /> L List up to ten addresses in the .pace below. Select ffJhb type(s)of files from the list below by checking he appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)4840138 or mail to the address indicated.above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day- <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. /� <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. (/ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑Map,—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> UNOERGROIINO TAM<(LIST) street R Street Name city <br /> • P SRLaR) <br /> m4: <br /> (N � ✓ <br /> J <br /> VFWZGRGOU9 W1 m 11f(1 a ✓/ 13 RY <br /> I/I TREO PERMITTED FACIUTY 2 l' JG � Fl 5�U <br /> DN <br /> I�(J GROONOTANK 7 <br /> MOWIOTNGI REMOVAL) �]PV�S <br /> OUS MATERNLS 3 <br /> 51UJF?MLEASERFrPONSE <br /> RTERQxR1IIY <br /> SOUDWASTE FAGIN /VEHICLE 4 <br /> ❑ <br /> FOOD FACT M <br /> ElDNRySPT) I �•.�1Y LVT �' 1 a�� � 9TE MmG.ngx <br /> aRr B <br /> ❑LANO LSE APPUC VON SITES <br /> ❑STIC PUMPER]RUCK I ❑HWSIKG <br /> 6 <br /> j'ARD/CHEWCAL TOu:ETs. <br /> ASTENATERTNEATMWT PLANT A <br /> ❑HO,IASING ABATEHEHT 7 <br /> ❑MQTF2/HOTe. <br /> ❑CHICKEN RMcHDOG KENNGUPA-U9T <br /> / EL <br /> ❑MEGIGALWASTEFACILRT 8 <br /> ❑ <br /> TATTMsoby,RERGNG ❑.seutw+.bl <br /> ❑WASTE TWE e <br /> ❑ YMPWNT <br /> ❑OTHER(P�empq SPECIFY): i]'ACOYJNIMG <br /> DB <br /> —!BOXED AREA-EHD USE ONLY- <br /> 11 <br /> II Records provided by Staff-PPR COMPIete: stair Names <br /> EMU a-UG _. <br />