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11/04/2011 14:33 8884443080 PEM PAGE 01/01 <br /> RECEIVED r1/ ..01, EHD LOG NUMBER <br /> DATE RFnrivFn SAN JOAQUIN COUNTY <br /> 04 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 600 East Main 5t. `u=Kton, CA 95202-3029 <br /> PERMIT/SERVICES Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICAT N . / <br /> APPLICANT: W,,�' BUSINESSIAGENCY: <br /> ADADDRESS;/5100fJ.. rr <br /> �� �r �( 0 CITY/STATEIZIP: q <br /> PHONE(2): FACSIMILE��e��� <br /> T TATIVE`APPOINTMENTDATE: Time:l-�T <br /> (Please allow 10 buainesa days IF to of application eubm 1 •Tonfat,"only-must bo oenfirmod) <br /> ❑CHECK BOX TO EXPEDITE REQUES - C 05 4C NLY)-REQUEST PROCESSED IN 3 BUSIN SD S <br /> SIGNATURE OF APPLICANT DATE l <br /> Electronic Information: ❑List❑ ap–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street>r Street Na a city ElUnitl <br /> _ /UO <br /> O - <br /> 2. �? <br /> - .. f � Ina1� D �� INO unit <br /> 3. P <br /> 4. o Un' <br /> 5• ( 5 ,No /u✓�itl3clV5 � j�j <br /> in d <br /> T. <br /> S. ❑Unite <br /> 10. ILI <br /> nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES /,, �`/._ G <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT tilty <br /> LID WASTE FACILITYIVEHICLE '01 l{fj kr <br /> M)THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY STE TIRE Wl l�7 y�( <br /> NDECROUND TANK(MONITORINCIREMOVAL) ❑DOG KENNEL WI , r+J <br /> UIC HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 11-1(4-11 <br /> IERED PERMITTED FACILITY ❑MOTEIUVOTEL ❑('UMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATT001BODY PIERCING ❑POOLISPA J�� ND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AMS:0OPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addressgs in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file typo MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addroeacs,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 files exist An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The Nes will be held for a maximum of five businvsa days fvi 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 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$122 deposit prior to review. <br /> EHe UBE ONLY <br /> -I e 1 1l ( 1 t? I j- r - <br /> EHD 41Dr 07=110 <br />