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i 300'd gV101 <br /> DATE RECEIVED EHD LOG NUMBER <br /> 1 <br /> SAN JOAQUIN COUNTY <br /> D ENVIRONMENTAL HEALTH DEPARTMENT <br /> p o ` <br /> CEN" 600 East Mair: S. Stockton, A 9 <br /> a , C 5202-3029 <br /> iTUephone: (209)468-3420 Fax (209)484-D138 Web: www.sjgov.argl�hcU 1 i <br /> f <br /> ... <br /> USLIC RECORD l RELEASE APPLICATION <br /> APP 7 � BU5INESSIAGEt�CY: <br /> ADDRESS: � 7��� � CITY/STATE/Zi P: <br /> PHONE(1): PHONE(2): FACSIMILE: q <br /> TEN ATIAPPOINTMENT DATE: • Time: <br /> (Ploaae allow 10 business days from date of a*01 ation submittal-`Tentative only-must be tonflrmad) <br /> Ej CHECK BOX TO EXPEDITE REQU�9�TllFEE(CASH OR CHECK ONLY)-REQUEST gROCESSPD IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 07-15-10 <br /> Electronic Informatlon: List Fj Ma —Descript.on: <br /> FILE ADDRESS _ _ EHD USE ONLY <br /> Street tI .Street Name _ city UnIt 1 <br /> Vnit 2 <br /> 4. _O. rD Gt I�OHGt '' G nit <br /> $• i h <br /> 7. <br /> 8. <br /> nit 6 <br /> Specific Date Range of Information Requested: From aI (de_si7 to <br /> f ENVIRONMENTAL HEALTH DEPARTMENT FILES " <br /> IYUNDERGROUND TANK(UST)CLEANUP SITE(LOP) YHO061NG ABATEMENT. u SOLID WA$TE PACILITYNEHICLE <br /> 20THER CLEANUP SITE(NON-LOP) ❑FO(ID FACILITY �ZWASTE TIRE <br /> Lv_I <br /> 2bNDeRGROUND TANK(MONITORING/REMOVAL) 0 Dcq;KENNEL DAIRY <br /> HAZARDOUS WASTEGrmERATOR; 0 CHICKEN RANCH RWA$TEWATERTREATMENT PLANT <br /> ©TIERED PERMITTED FACILITY ff mo mLIHOTEL PPUMPER TRUCKIYARDICHEMICA_L Tme-r5 <br /> ❑TAT7001BODY PIERCING ❑PCOLISPA LAND USE APPLICATION SIYE$ <br /> 12 MEDICAL WASTE FACILITY ❑OTII ER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOIL REVIEW: MONDAY-FRIDAY$:OD AM-5:00pM(EXCLUDING HOLIDAYS) <br /> i <br /> 1. List ue to ten_ad "in the space above. Select the type(s)of files from the list above by checking the appropriate I <br /> box(es). At least one file type MUST be selected. Fri, to(209.464-0138 or mail�qh2 address indicated above. Address i <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 files exit.% An appointment for review will be confirmed approximately ten(10) y <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. N <br /> 3. A file that Is actively being worked on by EHD staff rnAy not be immediately available for review. A new application may be <br /> submitted when the file IsLavailable. <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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane PJartinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHR 4$.09 — - 81 C9 <br /> Z00'd LZ:LO o>:oz-ST-enc <br />