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RECEIVEDEHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> APR 4 2017 ENVIRONMENTAL HEALTH DEPARTMENT '/� /aa <br /> 1868 East Hazelton Avenue.Stockton. CA 95205232 (vim �(l <br /> ENVIRONMENTAL HEALTH 454-0138 Web:www.sjgovorg/ehd <br /> • PERMIT/SERVICES nvtmnraentat EASE APPLICATION <br /> ppnrt Services <br /> APPLICANT., _ BUSINESS/AGENCY: <br /> ADDRESS: SITaf1r10n CaSfagnO CITY/STATE/ZIP:. <br /> PHONE(1): _ 30251 Golden Lantern, Suite#E-305 FAX OR E-MAIL' <br /> Laguna Niguel, CA 92677 eationsubmitialfortheteconistobeavidWNIs. <br /> Tel:1949-429-3564-Fax:949-429-3563 <br /> -date and trrreln revlenritte tegttested recoftfs <br /> ❑CHI Shan hon@Environ sMerl taIS upportServices cprYCHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1211,1110M DATE 4//.,,//7 <br /> 1. List up to ten addresses it a space below. Sel ct the type(s)of files from the list below by checking theappSgpriate <br /> box(es). At least one file type MUST be selected. Fax to(2091.464-6138 or mail to the:address indicated above. Address <br /> ranges will not be accepted.Applications received efter3:00 pm will be processed the,next.business day. <br /> 2. For assistance in identifying the nature and content of EHD 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 reviewwill he confirmed approximately ten(10) <br /> days 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 returned in the same condition as released will.he 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. 1! L 1 <br /> WELL AND SEPTICPERMII RECORDS AREAVALABLE FOR REV2& NCNDAY-FRDAY8:00AM6;00PM(E)CCLLDNGHOLIDAYS) <br /> Electronic Information: ❑List El Map—Description: <br /> Specific Dalale Range of htfonmauci t Requesterk From A 1/ to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK JUST) Street'Y Street Name city <br /> CLEANURSITEILOP)• JE1 CONSUMEro <br /> R[Jf OTHER CLEANUP SITE{NON-LOP) 1 �l5p( A4,j-1 m/J CWm/j <br /> ?la pernrman �r c57�oc��an <br /> �Hcc ATAPDOUS WASTE �t?AET <br /> TIERED PERMITTED FACILITY 2 <br /> Wy SOVEGRCU.ND TMTJ _. <br /> YUST(MONRORIN IRtIWVAL) QPWS <br /> Df MpROOUS.MATERIAlS a <br /> li(SPIWLTELEASE RESPONSE <br /> lEP rfUAkR'✓ <br /> SOLID:WRSYE�FACILITY IVEHKIE b <br /> Q FOOO;FACIUTY _ <br /> ❑POOL/SPA _. fT S/STEMM SATKIN <br /> F DAIRY T\ `+ Z l 1_4 <br /> ( ]LAND USE APPLICATION'SITES - <br /> Q SEFMC PUI(PER TRUCK) ❑NauR G <br /> 6 <br /> VARO7CNEMCALTaLETs <br /> WASTEWATER TREATMENT PLANT CUPA. <br /> ❑ij"INO ASATWENT .r <br /> MOTf11t1.OTEL <br /> rl CHICKEN RANCNI DOG KENNEL _ .... (UPA-UST <br /> II]MEOK:AL WASTEFACIL" <br /> TATTWSOOWPIERGINC <br /> D WASTa <br /> VWA_TIRE <br /> s <br /> ©CAMPIAIH{' <br /> QNF-1 OTHER(PUDkSE SPECIFY): o <br /> 10 <br /> ^BOXED AREA-END USE 0140— <br /> I <br /> E3 Records provided by Staff-PPR Complete.staff Name: <br />