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oan. l3. Au. VUUV <br /> . — r. <br /> • EHD LOG NLIMEER <br /> 01 '�� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JAN 13 2014 1888 East Hazelton Avenue, Stockttiii, CA 95205-8232 ` <br /> Telephone: (209)468-3420 Fax: (209)4840938 Web: www.gjgov.org/ehd <br /> ENVIRONMENTAL HEALTH � r, <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 6 6to BDSINESSIAGENCY: 5 0 <br /> C1VISTATE/IJP: H <br /> ADDRESS: S <br /> X5,33 � •�rr i" -��1°'�- <br /> PHONE(1)N, PHONED:(00)J /7.ggVIS FACSIMILE:�!a) frs4- Tfr9 <br /> TENTATIVE'APPOINTMENT DATE: 'I h/ Time: <br /> (Pleeea sHow 10 business days rrom d vYeppncsUen su m....•I 'Tkrrradve only-must co`dirmea ' <br /> CHECK DOX TO EXPEDITE REOUFB'T-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS _ <br /> SIGNATURE OF APPLICANT DATE1&�6-P A <br /> Electronle Information: ❑List❑Map—Descriptlonl <br /> P <br /> 'FILE:'ADDRESS" <br /> VVI surety ahsalNoma QNB Unit:l: <br /> RV,) +Mtn x cc <br /> ` <br /> "f I it Na m 5 G4 (wt . Nc r.xc i <br /> 7. <br /> Unhd <br /> unit e; <br /> specinc Date Range of Information Raqusetsd FMal I <br /> ENVIRONMENTAL.HEALTH DEPT <br /> 7MENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICALWAOTEFACI46 SOLID WAOMM FACILRYNEHICLE <br /> OTHER CLEANUP SnE(NoN•LOP) �HOUBINOAsATEMENT WABTETIRE <br /> UNDERGROUND TANK(MONRORINGIREMovAL) FODDFACILrrY DAIRY <br /> AEOYEOROUNDTANK ❑CHICKEN RANCH?DOG ONNEL WASMMVATERTREATAfEMPLpNr <br /> HAZARDOUSWASTEIHAZARDOUS MATERIALB ❑MOTWHOTEL PUMPER TRUCKIYARDICHUMICAL TOILET'S <br /> Tici;Ec PERMIITEO FACILITY ❑POOLISPA LAND USE APPLICATION SRES <br /> ,',,R 01 PERDUE O FACT Dg CoMPLAINTIREBPONS12 AFOORDe ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLH roR REVIEW' MON(SAY•FRIDAY 8:00 Am-5:00PM(EXCLUDING HOLIDAYS <br /> I. tial unto ten addrosseg In tho space above. Select the types)of flleiV from the list above by checking the appropriate <br /> LIst ). At leaet on file type MUST be selaoted. FAX <br /> to(anal aee.0t88 or mall m Ne address Indfccaa=' bns reoelVed afteer6 <br /> :angel will not be accepted-for addl0ona1 eeeletanee with Rle addrda&es, a] <br /> PST CMD. App <br /> pm will 4a processed the next buslnsea day. <br /> 2, -.v EHD will notify the eppitcanI If any e 0 t11ea axial An appofntmAiit for review will be conOrmed approximately ten(10) <br /> .: 's after receipt of application, The fires will be held Tor a mextmurri of flue business days for review. Appointments <br /> _..-,uld be echsduled aceordingly. <br /> 9. /. rile that le activoty being workad on by EHD staff may not be Immeillatelyavallable for review. A new application maybe <br /> e;:b)rn d when the Ols Is evellable. <br /> 4, 1..:r file not returned In the same condition as reieeead will be eeo s tPrior�ad o EHD staff at the exMa of the aQ Ilcant. <br /> '.:ire file reviews by the same spplicant may require a$126 deposit pilot to review. "'a1S>iis0'PRA aD 0-LE <br /> 5 .• �.. L'1'. r'1 G:fosccl e4te f• � ,,� '-�+}� <br /> IU '.:.crds,' rout e b Btaff P'PitCom ete .etanNama -�1R <br /> Received Time Jan. 13. 2014 1 : 34PM No. 4993 <br />