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08/08/2014 13: 09 80523996 SIERRA DELTA C0&'_T /01 <br /> Ij IEC <br /> ry 0010[PONUM R <br /> DATII>61�ECp +� SAN JOAQUIN COUNTY <br /> AUG 0 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, StOCktOn, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0136 Web: www.sjgov.Org/ehd <br /> ENVIRONMENTALHEALTH <br /> PERMIT/SERVIC'E.S(�I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AS bl M BUSINE53lAGENCY: �i��NSNS <br /> ADDRESS: (��`�•3,,??�� (Z.LLtt LL-t�s **-;"tCITYISTATEI2IP: <br /> 6PHONE <br /> P ,1QS `i3 fL&lo <br /> PHONE(1): - 931-`f 75`9- PHONE (2): FACSIMILE: �S' 9• �3D5 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Plasse allow 10 business days from date of appllaatlon submittal^-Tentebw only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-8126 FEE( OR ECK��rY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT G LoLhgbi ffv_ DATE / <br /> Electronic Information: ❑List❑Map—best n: <br /> FILE ADDRESS END USE ONLY <br /> Btreat i! /Street Name City UnH 1 <br /> 1. �( j Tt 6tS7 f'2 4V'F <br /> �•1� 3 Io S e -1 1 _A M M _ <br /> [I Unit.zU-< <br /> 322111 , �23 ' C1 <br /> B. 1 t <br /> 3 �\ �` `� .�Unit 4 <br /> L <br /> Unit 5 unu e <br /> Specific Date Range of Information Requested: From 1y to <br /> ENVIRONMFNTAL HEALTH DEPARTMENT FILES <br /> A NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILrrY ❑SOLID WASTE FACILITYNEHICLE <br /> �yPr'THER CLEANUP SITE(MON-LOP) ❑HOUSING ABATEMENT 2rWASTETIRE <br /> �VNDERGROUND TANK(MONITORINGIREMaVAL) ❑FOOD FACILITY ❑DAIRY _Y�-)N <br /> ,LI19OVEGROUND TANK ❑CNICKEN RANCHI DOG KENNEL ❑WABIENIATERTREATMEKT PL ANT <br /> ,&AATARDOUS WASTFJHA7ARDOU3 MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCKMARDICHEMICAL TOILETS <br /> ❑TIERED PERMrrTm FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIAAY 8:00 AM-S:DOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to tan address-aa In the apace above. Sated the type(s)of files from the[let above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-01311 or mall to the addrasa Indleated above. Address <br /> ranges will not be accepted-for additional assistance with Ole addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2, The END will notify the applicant H any EHD fllss exist. An appointment for review will be confirmed approximately tan (16) <br /> days after receipt of application. The filen will be held 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 /> A. Any flis not returned In th.same condiUen as released will be reorganl2od by END staff at the expense of the Ilcflnt. <br /> Future me reviews by the same applicant may require a$125 deposit prior to review. <br /> Cfo 5114 "r✓/' 4&01%-6 / q12) ,2dLysFvtr. i' __-- <br /> _ <br /> 1W �1rf pw ] f r^ 3 <br /> Iau1PP..FGFTl �I �Ji �"i.' <br /> Received Time Au,. 8. 2014 1 , 11 FM Ido. 6775 ' <br />