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-- EHD LOG NUMB --- <br /> SAN-JOAQUMC-OUNTY <br /> EC- 6 Ilk <br /> - <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 1 9 2009 600 East Stockton, CA 95202-2708 <br /> Telephone: (209)468- 2 464-0138 Web:www.sjgov.orgle <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS JPPLICATION <br /> APPLICANT: J� ��14 EZ) n'-t'CA I r•� SINESS/AGENCY: <br /> ADDRESS: Gq3 Ly Ur r�-� G✓C'k- CITY/STATE2IP 5 Gk- q 5 -2-o <br /> PHONE(11): (14, 1 4-24 -0(O'� PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEJ�T-$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT # 't. � DATE 01 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. <br /> ❑ Unit 2 <br /> 3. — - <br /> 4, Unit 3 <br /> 5. a <br /> e; - - ❑ Unit 4 <br /> 6. PIT <br /> 8 - ❑ Unit 5 <br /> g <br /> - ----- ` ❑ Unit <br /> Specific Da <br /> p to R$ff a In rmation Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES "pp �J�J <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT 13 SOLID WASTE FACILITYIVEHICLE �V <br /> CI OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY E3 WASTE TIRE I„iylly�I I(L <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY VV''�r'"•"`''��i°°'�., <br /> .XHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTEL/HOTEL E3 PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOOBODY PIERCING ❑ POOL/SPA ❑LAND USE APPLICATION SITES o <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS <br /> 1. List up to ten addresses in 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(209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten It 0) <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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> 'If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Th nk You' <br /> f <br /> EHD 48416 Aro 17nm <br />