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ME 03/30/20132 <br />® 0 <br />DAWRED <br />SQQyM SAN JOAQUIN COUNTY <br />PNOES ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton 05-6232 <br />le] Ie RTelephone: (209) 468-3420 Fax. 2 <br />(209) 464-0138 Webenue, StOCktan. CA 5www.s gov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />2001/001 <br />EHD LOG NUMBER <br /><1 <br />f /7 <br />APPLICANT:CrIn_ 900 j - Fro rcor\29FVlOo5' BUSINESWAGENCY: �Fnp,;gLaljrVl DQ <br />ADDRESS: 14fs ( � VQXpo rl� `fir)'yp { uA;+Z, ICM CITYISTATEIZIP: ScIQ,-0_nAVt�0, CA QSg,IS <br />PHONE (1): q((p^�$G' (Dc, PHONE(2): c11(o-4aC)-()60S FACSIMILE: 9(Cn-41,0-06os <br />TENTAT)VE`APPOINTMENTDATE: 10/(4/2013 Time: ! 9:00AF( <br />(1`14284 allow 10 busineee days from data of application submittal - 'Temadre oWy - moat be confirmed) <br />❑ CHECKBOX TO EXPEDITE REQUEST -$12n5 FEE (CASH OR CHECK ONLY)- REQUESTPROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANTK_DATE <br />Electronic Information: ❑ List ❑ Map- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Str«t s <br />— _ Strw Name <br />city <br />1. <br />IU _ <br />rlV2 <br />r C - <br />�jt <br />❑ Unn2 <br />2. <br />_. <br />3 <br />I] UNt 3 <br />A. <br />5. <br />7' urn4 <br />❑urns <br />6. <br />7. <br />_-. <br />e. <br />_._ <br />Unit e <br />10. <br />Specific Dale Range of Infum dlon Regwoxbsd: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILLS <br />9gq11 u <br />UNDERGROUNO TANK (UST) CLEANUP SITE (LDP) ❑ MED CAL WAsTe FAcLRY ❑ SOLID WASTE FACIM/VEHICLE rl I�Q�j <br />MOTHER CLEANUP SITE (NON -LOP) ❑ HDUSINo ABATlmDn ❑ WAST! TRIS �1 f ji <br />UNDERGROUND TANK(MONITORINOIRENOVAL) E] FOOD FACILITY ❑DAOtY O�J <br />A6ovEGRouwo TANK ❑ CWKEN RANCW DDD KENNEL ❑ WAsTEwATER T"Armor PLANT N" <br />rye* HAZARDOUa WAaTF1 ARDOue MATERIAL$ ❑ MOTELMOMLPUYpER NC <br />TRucKIYAKoICYEAL ToILETs <br />RED <br />TIEPeptaim O FACILITY ❑ POOUSPA �❑ LAN$ UsE APPLICATION Snra <br />U TATTOO/Bony Pa7tcwa �9 COYpLANT1RESPOME REcoRDs ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:D0Pm (EXCLUDING HOLIDAYS) <br />1. List up to (pit addresses In the space above. Select the types) of file& from the list above by chscking the approprletn <br />box(es). At least one tib type MUST be &Gloated. Fax to (209) 464-0138 or mall to the address Indicated above. Address <br />ranges will not be accepted - for additional assistance with file addressee, contact the EHD. Applications recctved after <br />3:DO pm will be processed the next business day, <br />2. The END will notify the applicant H any EHD flies exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The flies will be held for a maximum of five business days for review. Appolntmenta <br />should be scheduled accordingly. <br />3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A now application may be <br />submitted when the file Is available. <br />4. Any filo not returned In the same condition as released will be Teorgenizad by EHD staff at the expense of the applicant <br />Futuro filo reviews by the same applicant may require a $125 deposit prior to review, i <br />