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rM Jan, 13. 2014 1 : 29PM No, 0860 P. 1
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<br /> no NED SAN JOAQUIN COUNTY L:HD LOG NUMBER
<br /> ENVIRONMENTAL HEALTH bEPARTMENT 6\%3
<br /> JAN 13 2014 1868 East Hazelton Avenue, Stockt6d, CA 95205-6232
<br /> . Telephone: (208)468-3420 Fax:(209)464-01-38 Web: www,slgov.org/ehd
<br /> ENVIRONMENTAL IICESL�H PUBLIC R9CORDS RELEASE APPLICATION
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<br /> APPLICANT: K&sgx 6jt e-- t BUSNESSIAGENCY:6KAS L^rlylfOr�rNiw�+.l w�.
<br /> ADDRESS: W5 B -54y&t dtYISTATE/IJP:. k6%W,,M {�6 9yS y/
<br /> PHONE(1):, z 7�y3S-�l t? PHONE ):Ls►o)xN 7-q gg5 FACSIMILE:( 10) y9 ��...
<br /> TENTATIVE`APPOINTMENT DATE: Time: / .00
<br /> (Please allow 10 business days from Ift WapplicwtIon au m I-•Ti Milve only-must be confirmed C.
<br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT. DATE 12-A aJ►3
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<br /> SpeciOc[late Range of Information Requested: From All to
<br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILU
<br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY 10 SOLID WASTE FACILIWIVEHICLE g-
<br /> OTHER CLEANUP SITE(NoN•LOP) HOUSING ABATEMENT WAm TIRE
<br /> UNDERGROUND TANK(MONrroR1N(31REWVAL) HFOOD FAclury DAIRY
<br /> ACOVEGROUNDTANKCHICKENRARCHIDosWNEL WASTEWATER TREATMENT PLANT
<br /> HAZAm ioUSWABTFIFImRDmus MATERiAL8 H MOTFt1HOTEL PUMPER TRUCKIYARDICHEMICA1 %LETS
<br /> TTI:',,ED PERMITTED FACIUTY POOLISPA LAND USE APPLICATION SMiS
<br /> t F,+7oolBobY PIERCING CDMPL.AINTlRE6PDN5i RECORDe OT
<br /> (PLFAeE SPECIFY)
<br /> WELL AND SEPTIC PERMIT RF-COKDB ARE AVAILABLe Boli RwEw: Mog0AY-FRIDAY 8:00 AM-5:00PM(ExCLUDINO HOLIDAY
<br /> 1. Listyu to 11n addreesea In the space above. Select the type(s)of fllei from the list above by checking the appropriate
<br /> box(es). At least one file type MUST be selected. Fax to Qg)484.0199 or mall to the address Indlcated Above. Address
<br /> a ngea will not be accepted-for additional assistance with file addrd"ea,contact the EHD. Applications received after
<br /> pm will be procansed the next buelneae day,
<br /> 2. 7.-.Q EHD will notify the applicant If any EHD filen exist. An appalntmd4t for review will be confirmed approximately ten(10)
<br /> ,`a after reaelpt of application. The files will be hold for a maximurh 6f five business days for review. Appointments
<br /> ..,uld be scheduled acoordingly.
<br /> 3. t, file that Is actively being worked on by END staff may not be Immediately available for review. A new.appllcatlon may be
<br /> cvbmltted when the filo Is available.
<br /> 4. /-,,y file not returned In the same condition as released will be rearganlied by EHD staff at the expense of the ap llcant.
<br /> .:,re file reviews by the some applicant may require a$126 deposit prior to review. ' �p:KI `
<br /> res;" Ar6vlded.'b j Stiff-PPR Coin• letii.staff Name:
<br /> FHD.i•';R ..14112
<br /> Received Time Jan. 13. 2014 1 : 34PM No, 4993
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