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' r 23 2014 11 : 06AM THE UPS STORE 2503 9167251772 p. l <br /> 41 <br /> �■r }1 ,E.1 \ f a <br /> �, 1 . <br /> EHD LOG NUMBER <br /> ■ <br /> 12ATE REceivEr3 SAN .JOAQUIN COUNTY 1 OR 2 3 2014ENVIRONMENTAL. HEALTH DEPARTMENT ' L <br /> to A 95205-6232 f <br /> 1888 East Hazetto n e, <br /> ��ERM EOVI�o�Vilophone: (209)468-342 ax: (209)464-013$ eb. www.sjgcv.org/9hd <br /> PUBLIC RECORDS R APPLICATION <br /> APPLICANT: 1� I l I/ ��` BUSINESS/AGENCY: G 4? -�1:1: <br /> ADDRESS: /„ /e rr. G a�-a �� �� CITY/S7ATE21P: Cl '� �G,�C"\ S �� <br /> PHONE(1); 6, 3 7 PHONE (2): FACSIMILef? 2ctz <br /> TIE T�"APPOINTMENT DATE: Time: o 2 a <br /> (Please allow 10 business days from date of applies on submittal-'Tents a 7wy-must be confirmed <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CA H 4R CH CK ONLY)-REQUEST PROCESSED IN 3 P <br /> USINES DAYS <br /> SIGNATURE OF APPLICANT DATEeZ <br /> Electronic Infottnation: ❑ List❑ Map--Description: <br /> 1, FILE ADDRESS EHDa LY <br /> Il g�e1 s Street Manns //city` �—� unit 1 <br /> ttMa✓L 2, Zy .c�� ( �s (r�(s;�, i 19 p tz unit z <br /> 3. <br /> 4, 0 Unit 3 <br /> 5. J <br /> T, <br /> Unit s <br /> 10. unit s <br /> Specific Date Rongs of Information Rsquooted: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )r- <br /> N013tti MND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WA.BTE FACRlfY ❑SOLID WASTE FACLrry eHICtJC��I,e7 <br /> THER CLEANUP SITE(No+LOP) ❑Houma AaATEelw ❑WAsTE TIRE 311, �j <br /> ND TANK(MONITORINGIREMOVAL) H FooD FAr.LnY ❑DAIRY <br /> GROUND TANK QwcKPN RAmcW DOG KENNEL ❑WA$TEWATETi TREATM>NT PLAINT 5"�� <br /> AZAFMOM INWE HAZARDOUS MATERIALS S MOTELIHOTEL ❑PumPEA TRucmNARPICom9cAL TOILETS <br /> TIERM PERWIT1:D FACILITY ❑PC+Ot/SI'A ❑LAW USE APPLlCAiION SITES <br /> ❑TATTooBODY PIERCING ❑CowLAINTIRESPcm3E REcros ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00m(EXC LUDINO HOLIDAYS) <br /> 1. I.let un to ten jiddregy4s In the space above. Stalest the type(*)of flies from the list above by checking the appropriate <br /> box(es) At least one filo typo MUST be selected. Fax to 009 484-0130 or mail to the ddress Indicated phove. Address <br /> ranges will not be accepted -for additional assistance with flip addresses,contact the ERD. Applicmtlons rscetvod after <br /> 3:00 pm will be procassed the nofd business day. <br /> 2. The EHD will notNytha applicant It any EHD flies exlst. An appointment for review will be confirmad approximaWlyten (10) <br /> days after receipt of applkatlon. Tho tiles will be held for a maximum of five business day* for revlew� Appointments <br /> should bescheduled accordingly. <br /> 3. A file that Is actively being worked on by EHG staff may not be Immediately avaliable for review. A new application may be <br /> submitted when the the Is avallable. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff s2 the expanse of the applicant. <br /> Futuna file reviews by the same applicant may require a$125 deposit prior to review. List OWLY <br /> Z c <br /> -o <br /> .�, `'�:: S '..D2� �y ...XML'-��( :k;S,�.�d2�.,� ��e�' .p� ;_`�� „�'2 Z�'• '�3� - <br /> '. <br /> <C000 12z,Jcl N11 3 �or 2$Ob C I rnIG r�s}s <br /> Receiv d Time Apr. 23. 2014 12: 14PM No• 5863 <br />