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REQ&-jVED A SAN EHD LOG NUMBER <br /> .IOAQl11Pi COUNTY' <br /> nrT (. 0 20F o ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232- <br /> ENVIRONMENTAL <br /> 5205-8232ENVIRONMENTAL HEALTH Telephone:(209)468-3420 Fax:(2091464-0138 Web:www.sj-qov.orglehd <br /> PERMIT/SERV►CEg Shannon Castagno ASE APPLICATION <br /> 50251 Golden Lantern; Suite #E-305 <br /> APPLICANT: _ Laguna lufguel, CA 92677 _PUSINESSIAGENCY: <br /> ADDRESS: _ Tel: 949-429-3564 -Fax. 949-429-3553 — CITYISTATE1zIP: <br /> PHONE(1): _ Sha-nnon@a EnvironmentalSup:portServices_com. FAx OR.E-MAIL: <br /> Please allow 10 husiness 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 EKPEDIT'E R EST-$1;39 FEE(CASH OR CHECK ONLY),REQUEST PROCESSED IN3. BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_ )OMOP-1 <br /> 1. List up to ten addresses in the'pace'below. Select#&type(s)of files from the list below by checking Zhe appropnate <br /> box(es). At least one film type MUST be selected. Fax.to(209)464-0138 or Marl 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 EI41)will notify the applicant if any EHD files exist, An appointment for review will be conflirm6d approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business clays 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 /> lot�0 <br /> WELL AND SEPTIC PERMIT RECONS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ANI-5:00PM(EXCLUDING HOLIDAYS) <br /> - <br /> ElectronIc Information: 0 List❑Map-Description: <br /> Specific Date Range of lhformation Requested: From All to <br /> ENVIRONMENTAL- <br /> HEALTH DEPARTMENT FILE .ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street#k Street Name City <br /> �tF%NUP SII-B(LOP) -. (��► i`' �W"Su ut <br /> �rvJ THER CLEANUP SITE(NON-LOP) � �?�� �,fGS� JiCt' 'iC�. S�QC�6 <br /> '.VHAm.ROCUS WASTE IW I <br /> DA]RY <br /> T1,REP PERmiTTm FACuTY 2 .//� � [� /� <br /> VEGROUAOTANA I7 Sl r/ (a/'ts>t 1' &I11AEr tan C— 15 eV NOW Nm 1 <br /> Flo r (MON[iORI a 1 REMOVAL) _ .. . .. Q PWS <br /> u.. OUS MATERIALS _ <br /> 7M , &Z--S t Hamner lane- ,S c' <br /> 8PIWR�LBASE RESPONSE - - <br /> WATI_R C't1.4LfrY <br /> SOLID WASTE FACILITY I Vail � [ <br /> R W 1/,, ,1 J • r <br /> Fooa FACILITY 7 s6 F.sr !r•tj ne, TOG �"� <br /> POOL/SPA 'SRE'MR wmr4 <br /> I7 DAIRY 5 <br /> CLANG USE APPLICATION SITES. I <br /> )7&a FrV .. ]YAC ktl <br /> n sEnia PumPERTRI.GK 1 [I HouslHc' <br /> 6 <br /> �SIdU 1 CHEMICAL TOILETS Y <br /> WASTEWATER TREATMENT PLANT CUPA. <br /> HOI )SING ABATEMENT rTj�/hl <br /> MOT�LIHOTEL I� <br /> rl CHICKEN RANCH 1 DOG:KENNEL _ (lAA`6W <br /> fl MEDICAL WASTE FACILITY $ () <br /> TATTOO/BODY PIERCING <br /> WAM-E.TIRE ..�SouplNhss <br /> 9 <br /> El GOMPLM0 <br /> n OTHER(PLEASE SPECIFY): - <br /> �AccpUNriuG <br /> fo <br /> "'ECXED AREA-EHD.USE ONLY— <br /> u� A�� {ry��:" �- 'lc to� X11% +`IJ r �`1 '✓;,v✓� ��'---' <br /> I - - - <br /> 13 Records pravided by Staff-PPR Complete-.Staff Name- <br />