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■ RECEIVCt�, <br /> SATE RECEIVED JL EHD LOG NUMBER <br /> SAN.lOAQUIN COUNTY <br /> ■■ 101i )?," ENVIRONMENTAL HEALTH DEPARTMENT QQ1 <br /> ■ 1866 East Hazelton A 95205-6232 <br /> 04VMONIAMALHE phone; (209)468-342 ax: 209)464-013 www.P ov.or leh <br /> F iT�f l PUBLIC RECORI=}S RELI�A E A AICA �N <br /> • <br /> APPLICANT: G(12ST 6-cvf, 13USINE881AGENCY: <br /> ADDRESS; f 1 Pad Cl YIS ATEJZiP:__CAjm,�r C.C] GIS-Q� <br /> PHONE(1); PHONE *X4)R_r•WlL, <br /> (please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK SOX TO EXPEDITE REQUEST-S139 FEE( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2 <br /> 1. List tip to ten addmaseg In the space below. Select the type(a)of files from the list below by checking the apprbpriate <br /> box(es): At feast one file type MUST lie selected. Fax to{20 X1464-0i $or mall to the re s Ddicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance In identifying the nature and content of EHI]records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> day$after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returnee!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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> NDFRGROUND TAE!!,(VST) stmet; $tract Name city <br /> �OLFJ81TH(LOP) ❑����� <br /> T'SiERWUF°Ce�PWUP SffE(NoN•LOP)` <br /> 1 '► � s-��,c ilk c {�r,� V0 <br /> �i� A7aWaA0Us WASE@ ❑DNRY <br /> ERGD PgRNITTED FACILITY 2 <br /> OVEGPOUND TANK --- <br /> t]P1Y3 <br /> U$T (MONITORING l REMOVAL) <br /> IGC�[7..,AlF(/ ()GUS MATERws <br /> SRLURELEASE RESPONSE ,yxEq,]u/.f,JTY <br /> blf"WASTE FACSLIIY I VEHICLE A <br /> n r000 FACILITY <br /> "F,-- <br /> El Pool 1 y�A <br /> E�DAIRY 6 <br /> Lj LAND UaE APPLICATION+=TIES 3EPTIG P�11uIPER TRLLCIG YAR4t cker�ISAL rDILETs E]WnSTEWATER TOC.ATMENT PLANT <br /> HOUSING ABA-MmENT y . <br /> MOTEL'KOTEL <br /> rl cUPA-UST <br /> G?[tcxEW RANci-I 1 b00 f4¢N*+EL <br /> ©MLOICAL WASTE EAC[Ln—Y <br /> [ TATT00I609Y PI6RCI40 pUo Wnare <br /> Il WASTE TIRE <br /> OTHER(PLEASpECIFY)_ ❑AGGaUlfnu6 <br /> C$ <br /> 10 <br /> i l N <br /> �j-'ZLi-l-T- CA1ek LC(`\t Vt- 116i _,l A G n��ni1� �'.4w\klL' �Lll"�i Imo!awti <br /> n apri.,rdot nenvlded by Staff-PPR Complete- Atme Name: V <br /> Received Tifrie=May, 23. =2317= 5s25PIV No, 1 )67 <br />