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rl': Fega 2 0}2 2014-04_90 14:54:22(GMT) P 1856H02H02T,"Fra�:pp Myron OI¢on <br /> DATER �j � ',, Ebro LW NUMBF , <br /> RECEIVE"" SAN JOAQUIN COUNTY <br /> APR.3 0 2014 1868 EasstUHazelton AvenNTAL ue, Stockt , CDEPARTMENT96205-6232 <br /> �,+ _ <br /> Telephone: (209)468.3420 Fax: (209)464-0138 Web:www.sjgou.org/ehd <br /> E. FIONMENTALHEALThI F tsrtlett�.� ina�aeir i. too. <br /> PERMITISERVIOFOUBLIC RECORDS RELEASE AP'PLICAVON <br /> APPLICANT: fS, B.USINE$SIAGENCY: 3 Est L :Ylllfl+ j€1ITT l <br /> ADDRESS: ©j CITYISTATE/ZiP: ilt <br /> � E <br /> PHONE (1): .$"/t"J � � � %S 3 PHONE(Z): FACSIMILE <br /> TENTATI VE'APPOI NTM ENT DATE, Time: <br /> (Please allow 10business days from date of application submittal-'Tamauve anty-must be confirmerij <br /> [jCHECK BOXTO EXPEDITE REOUES7`4125 FEE(CASH O CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE '" - <br /> Electronic'Hnformation: ❑ List❑ Map—Description: <br /> _ FILE ADDRESS EHDUSr ONLY <br /> Streat#lamo _ fA}:- Cid' _ unit 1 <br /> _ <br /> 2. Kl' Unit <br /> 3. <br /> 4• 1 Unft3 <br /> T. <br /> 8. I Bunn s.. <br /> 9. ( __ <br /> 1o. # L/J Unit 6 <br /> Specific LTata.R.anse of Information Regyested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACIUTYM141CLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> MAaUNDERGROUND TANK(M0111WRINGIR.EMOVAL) E]FOOD FAaITY ❑DAIRY V'�"�-'le <br /> uveckOUNDTANK El CHICKEN RANCH!Dull KENNEL El <br /> TREATMENT PLANT <br /> }HAZARDOUS WASTEIHAZAROOUS MATERIALS ❑ i_ <br /> MOTELIHOTEL .I PLIMPERTRUCOARDICHEP.ICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION Slits <br /> ❑TATTOolBODY PIERCING 'COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AMr5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to tan addresses in the space above. Soleet the types).of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 1209)464.11138 or mail to the address indicated above. Address <br /> ranges will hot be accepted-fee additianai.assistance with toe addresses,contact.the END. Applications.recefved after <br /> 3:00 pm will be processed the.next business days <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be^confirmed approximately ten(10) <br /> days after recelpt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be soheduted accordingly, <br /> 3. A file that Is actively.being worked on by EHD staff may not be,immediately available for review. A new application may be " <br /> submitted when the filer is available. <br /> 4 Anyflle not returned to the same condition as released will be reorganized by EHD staff at the expense of the a pllcant <br /> Future file reviews by the Sarno appilcant.may require a 5125 deposit prior to review � 3„�"$ i'r "�i%y/,)) $,�fl.,Nl,)'r <br /> �-T*^�� I�r x{g h: xyY+"a 4'1:•�,nitit> .;-t' 'vC .nn.4'T.. ik 3''r'i,sa4t s->. .y <br /> sea aeds 91NS2 <br /> —Received Time—Apr. 30. -2014— 1:52AM—No. 5926 <br />