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06/27/2012 08:32 9166486688 ADR _ PAGE 01/01^-- <br /> 1 <br /> EU SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JUN 2 7 2812 ENVIRONMENTAL HEALTH DEPARTMENT600 �I <br /> -3029 <br /> Tei phone: (0) 4681 420 Fax: (209Main Street, D 464- <br /> ENVIRONMENTAL 38 Webckton CA 2www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTFf ) <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I I fFSIfG BUSINESS/AGENCY: �K 1=N VnDNgprN lel E1Ldy <br /> ADDRESS; 2Zf'j 1 CGI" fp'1UZ'� city/Stato/zip 6jZ-Ct>AH�h U4 9!8/6 <br /> PHONE(1): yi L-1ZI.000 PHONE(]); <br /> FACSIMILE: yIG-69T4-66L'� <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from dote of appllCstion eubmittai-•T me. <br /> enief/ve onlyy.must be confirmed) <br /> O CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Jw( 10, 2017- l() 4"f <br /> DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS n <br /> Street# Street Name City <br /> 1, 1313 sours, Sladeh SIvebt- Loll' <br /> 2. <br /> 3. <br /> 4. r� <br /> 5. r YJ <br /> 8, Unit <br /> 7. <br /> 8.10. / <br /> Specific Date Range of Information Requested:From �Il to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES qj <br /> L'f UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 11 SOLID WASTE FACILITYIyEHICLE <br /> �QTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 13 WASTE TIRE <br /> Mf UNDERGROUND TANK(MOMTORING/REMOVAL)47— ❑DOG KENNEL 12 DAIRY -7 <br /> Ie HAZARDOUS WASTE GENERATOR d- []CHICKEN RANCH IV WA6TEWATCRTREATMENT PLANT <br /> VTIEREDPERMITTEDFACILITY ❑MOTELIHOTEL ❑PUMPER TRucK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING Cl POOLISPq <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) LAN-USE APPLICATION SITES <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILAELE FOR REVIEw- MONDAY.FRIDAY6:DDAM-5:00PM - EXCLUDINGHOLIDAYS. <br /> 1, List up to ten addresses in the space above. Select the type(s)of Hies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to[209)464-0138 or mall to the address Indicated above 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 fifes exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 now 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> od d t 5 coDOa 7 F <br /> r 4341\0. Fog <br /> Received Time`Jun. 27. 2012 8:21W-N0. 0369 PUBLIC RECORDSRELEASE APP FORM <br />