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" r'HUt 191 <br /> SAN JOAQUIN COUNTX ^� - <br /> ElN "AONMENTAL HEALTH DEPART . 'IVT <br /> 304 East Weber Avenue, 3rd Floor, StOcktOD, CA 95242-2708 <br /> Telepboae: (209)468-341Z0 Fax: (209)464-0138 Web:wwwzigov.org%ehd I / <br /> PUBLIC RECORDS RELEASE APPLICATION / <br /> / APPLICANT: i LIC - <br /> ' AtMVESS; 311140 tJ_ R - BUSINESSIAGENCY: ,IIAKK 1 b assn_ <br /> PHONE(1): 234- 7722 PHONE cell //� - <br /> (21 )47�7(4L FACSIMILE: ILC h )23q -7727 <br /> j TENTATIVE'APPOINTMENT DATE; Iw0 6 <br /> c. (Please allow 10 business days from tate ora Time: Itit a;r <br /> ppOcaGon tubmhtal-•TettWGve only-must be Conti ed) <br /> C7 CHECK BOX TO EXpMrr F <br /> fs• 3AATURE OF APPLICANT <br /> j1. .CkSH--OR CHECK ONLY)-REQUEST PROCESSED IN a BUSINESS DAYS <br /> t • _DATE 12/22/os <br /> ..r:7 oISTRIBVT1pN O Unit1 ❑UNQ l7 Wta O Unit.t o U <br /> _ Mt 6 O UnN s C3 mer(eleclrontdli-etshnaptA <br /> ---- PILE ADDRESS <br /> 1 <br /> street r Stmt Name Cay EHD USE ONLY <br /> 2, 5,L9-1 owJ ,N} <br /> 3 3 it T- li <br /> 4 <br /> 5 - <br /> e, � <br /> 9. <br /> 10, <br /> ;.er fic Date Rango of information Requosted:From II <br /> to <br /> f ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ` UNDERGROUND TANK(UST)CLEANUP Sr!(LOP) HOUSING ABAT mew IQ Sa.w WASTE FACIUIY)VEMCLE <br /> f1 OmEr,CLEANUP SrTE(NON-LOP) Food FACLfTY 0 WAsTrTate <br /> UNDERGROLUD TANK(MONITORjNQ REKOYAL) 0 Doo KENNEL 0 DAIRY <br /> RAZAADOUS WASTE GENERATOR - tl <br /> . CFFCKE'.(�t <br /> tl WASTEWATERREA 71Ef.:D PERIrTED FACliY tl MOTEFOTEIn PUMPER TRUcKWARDfommTo4LE <br /> T$ <br /> TA TT(X4VODY PUERCm0 '❑POOIISPA ❑LANo USE APPLr_ATION SRES <br /> i tD MEW AL WASTE FACV Y tl OTHER(PLEASE SPEGPT) <br /> .T WELL AND SEP=PERMIT RECQRDS ARE AvAlLMLE rat REVIEW- MONDAT-FRIOAT e,00 AM-6:00m - EXCLUDING HoLmAn., <br /> t up to ton addresses In the space above. Select thetype(s) of files from the list above by checking the <br /> propriato box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> i.;:1iu,ted above. Address ranges will not be accepted-for additional assistance with file addresses,Contac, <br /> e EHD.Applications received after 3:00 pm will be processed the next business <br /> day-EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> r,nox mately ten (10)days after receipt of application. The files will be held for a maximum of five buSlnes: <br /> s; s for review. Appointments should be scheduled accordingly. <br /> 1 pile that is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> ppdcatlon may be submitted when the file is available. <br /> iy file not returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> 13I.IicanL Future file reviews by the same applicant may require a$93.00 deposlt.prior to review. <br /> 4 <br />