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PAGE 62102 <br />05120!20113 I1:37 269333FLODI DOWNSTAIRS , <br />t� <br />ZHO LOG NUMBFFt <br />DATE RECEIVED -SAN JOAQUIN COUNTY <br />.�� ENVIRONIIIIENT ��t�'SEock oH, DEPARTMENTA g5 02 c 29 <br />600 E2st Main Street, <br />MAY 2 1 ZU 1.0 "Telephone: (209) 468-3420 Fax: (209) 464-0138 Webs www.s}gov org/ <br />ADDRESS: <br />PHONE (1): <br />HEALTH <br />in kFcORDS RELEASE APPLICATION <br />9p2 rndus�1a1 Wad..._ _ cltylstatur�lp �� • <br />_ <br />FACSIMILE: ng-�4-4228 _ <br />7t1A-'� z_37U PHONE (z): - gam <br />Time= <br />TENTATIVE* APPQINTMENT DATE: G-3-'� <br />it 10 Gusto®ss days frorrl data of application submlttal - "Ten0tila only -must be confirmed) <br />(Please a aw <br />❑ CHECK BOX TO EXPEDITE REQUEST - $105 FEE (CASH OR CHECK QNI.Y) - REQUESY PROCESSED IN s I3LfSINESS DAYS <br />DATE 541-10 <br />SIGNATURE OF APPLICANT <br />Information: ❑ List_❑ MsP — Description: <br />Specific Date Ranga of Information Ftequastedc From to <br />ENVIRONMENTAL. HEALTH DEPARTMENT FILES <br />XUNp>=RGRQllND TANK (UST) CLEANUP SITE (LOP) <br />[7 HQUsiNG ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br />�FACILITY 17 WASTE TIRE <br />OTHER CLEANUP SITS (NON -LOP) 17190P 10 DAIRYST <br />UNDERGROUNQ TANK (MONITOR1NGIRF-MOVAt) ❑ DOG KENNEL <br />HAZARDOUS WASTE GENt:RATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />CK TIERED PERMITTED USWAST GEN% A ❑ MOTELIHOTEL F3 PUMPER TRUCKfYARDICHEM TOILETS <br />[3TATTOQIBOOY PIERCING l3 POOLiSPA C-3 L -mm USE ApPLiCATIDN SITES <br />O MEDICAL WASTE FACILFrY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FQF: RFml:w - MONDAY -FRIDAY 8:00 AM W:00PM - EXCLUDING HOLIDAYS, <br />1. List up to ten addresses in the spam above. select the type(s) of files from the list above by checking the appropriate <br />tiax(es). At least one iii®type MUST be selected. F o 09 x640138 or mail o the ad ess indicated above. Address <br />ranges will not be accepted —for additional assistance with file addresses, contact the EFID. Applications received after <br />3:00 pm will be processed the next business day. <br />An appointtnentfor review will be confirmed approximately ten (1t1) <br />2. The EWD will notify the applicant If any EYiD files exist. <br />days after receipt of application. The files will be hold 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 avallable for review. A new application may be <br />submitted when the file Is available. <br />4. Any file not returned In the same condition <br />released will be <br />reorgan dr to review. by ft at the expense of the applicant. <br />Future file reviews by the same appcent may require e a $105osis pprioro <br />EHD USE ONLY <br />