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04/18/2007 11:17 5 08340152 PAUL H KING PAGE 02/02 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> T'WRONMIENTAL HEALTIi DEPART1V ENT <br /> 304 l ast Weber Avenue, 3r1 Floor, Stocictoll. CA 95202-2708 ."70 <br /> Telephone: (209) 468-3420 Fax: (209) 461-0138 Web: Nvww.sjg0v.0rg/elld <br /> iJSL1C RECORDS R ._070 <br /> LLASL APPLICATION — <br /> ;� h I L ' <br /> � BUSINESS/AG NCY: t t.� '�rEY11L�" <br /> APPLICANT: <br /> ADDRESS: C` l� ��- '7�� � <br /> PHONE(1): <br /> p PHONE(z): FACSIMILE: LI;L� <br /> TENTATIVE"A POINTMENT DATE: <br /> �( f 1-1,ru $`� Time; (O �r 11 141ti'l <br /> (Please allow 10 business days from date of application aubmlttal- Tentative only-must bo confirmed) <br /> C CHECK BOX TO EXPE ITE REQ EaI-$95.0 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICA14T " rn DATE <br /> Electronic Information: List❑ Map--Description: <br /> USE <br /> FILE. ADDRESS..-.--- EHD USONLY <br /> SE O LY <br /> _—. --- — Elunit 1 <br /> Street# Street Name _ __ <br /> Sou <br /> - .�-1�k ❑ Unit <br /> 2. <br /> _ 3 _ . (o S c-n_ -til s A-v t S�-r 4k 1� - <br /> / -- --- Unt3 <br /> 4. - - ' v A.- <br /> - - -- <br /> �Unit 4 <br /> ---- --- — <br /> -7 - - --.. ..__ ❑ Unit 5 <br /> 9. - -- ❑ Unit s <br /> 10. ..._ <br /> Specific Date Range of Infer ation Requested: From 1'j to <br /> ,�� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L.I UNpFRGROUND TANK(UST)CL NUP SITE(LOP) ❑ HOUSWG A13ATFMENT tl SOLID WASTE FACILITYNFMicLE <br /> I� <br /> 0 HER CLFANUP SITF(NON-LO ) El FOOD FACILITY ❑WASTE TIRE <br /> L UNDERGROUND TANK(MONITORI GiRFMOVAL) 0 DOG KENNEL M DAIRY <br /> M'DAZARDOU9 WASTE GENFRATO ❑CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> dTIEREDPERMITTEbFACILITY d MOTEUHOTF,L ❑ PUMPER TRUCKIYARD/CHEMTOILETS <br /> ❑TATTOOIBODY PIERCING n POOL/SPA ❑LAN❑USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC P 'RMIT RECORDS ARE AVAILABLE rOR RevlEw - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses n the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to los 464-0138 or ail to the address 1 dicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD.Applications received after <br /> 3:0 pm will be processed the next business day. <br /> 2. The EHD milli notify the a pllcant If any EHD files exist, An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of appl�catlon. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled ac ordingly. <br /> 3. A file that Is actively bel g worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file i available. <br /> 4. Any file not returned in t e same condition as released will be reorganized by EHD staff at the expense of the applicant, <br /> Future file reviews by thq same applicant may require a$95,00 depoait prior to review. <br /> EHD USE ONLY <br /> END 49.06 91131200E - <br />