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�■ 08/08/2014 13:09 8052399309 SIERRA DELTA CONSULT PAGE 01/01 <br /> I ■ <br /> ■ <br /> I ■ , <br /> EHD LOG NUMBER <br /> �■ <br /> DATRECEIVED EIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH �� <br /> AUG 0 8 2014 1868 East Hazelton Avenue, Stock taft, <br /> Telephone:-(209) 468-3420 Fax: (209)464-0138 Web. www,sjgov.org/ehd <br /> 4 ENVIRONMENTAL HEALTH <br /> .1 PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: St�� BUSINES3IAGENCY: sl�^�`�� '�r'`-� �Sw <br /> ADDRESS: I S ups �`c CITY/STATE/ZIP: Is <br /> qqtp <br /> (�,��..., FACSIMILE S'g3 I• c9 3'D5 <br /> 6 <br /> PHONE(1): � - � `{ `a- (PHONE(2): <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentettve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE( OR ECK Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT `-°"Gt Gi ZV� DATE <br /> Electronic Information: ❑List[3 Map—Desc n: <br /> FILEYADRESS <br /> END USE ONLY <br /> she,# StrCity Unit 1 <br /> F2./i <br /> •- 1�t Qt f� MCI p 3 O S M >✓-2 c a(, ❑Unit 2 c1/ <br /> 3 r 1 't 1 i �1, 'L `�1 12-11'�I, <br /> 4. ' � � ��( I• q cj,5,Jr L ��l` Ll Unit3 <br /> 5. <br /> 6. �Unit 4 <br /> a 7. <br /> 13. Unit 5 <br /> 9. <br /> 10. , Unit ti <br /> Specific Date Flange of Information Requested: From , <br /> to d <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X NDEROROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ,OWASTE TIRE <br /> �BI7NDERGRDUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY []DAIRY <br /> JZAI3OVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ,PNAZARDDUS WASTEIHAzARDOUS MATERIALS El L]PUMPER TRUCtK/YARDICHEMICAL TOILETS <br /> - <br /> TIERED PERMITTED FACILTTY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATToOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY--FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> I. 1.10 u to On address In the apace above. Select the type(6)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fm to(2091464-0138 or mail to 1116 address Inoicated gbove. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD, Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2, The EHD will notify the applicant If any EHD flies exist. An appointment for review will be conf7rmed approximately ten(10) <br /> days atter receipt of application. The files will be held for a maximum of five business days for review. Appointments <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 new application may be <br /> submitted when the file Is available. <br /> 4. Any fila not returned In th■same condition as released will be reorganized by EHD staff at the ex ansa of the a licant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review.giv <br /> 1 � <br /> g. <br /> y <br /> Received Time A - 201 �No 6775 wvlz <br />