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01_/_07_/2013 15:47 4693851599 GAZATECH PAGE 01/01 <br /> CHO LOG NUM9CR <br /> TSAN JOAQUIN COUNTY <br /> EIV <br /> ,CED <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JAN 0 7 2013 18(2 East Hazelton Avenue,09)464 0138 Web52www.s gov.org/ehd <br /> Telephone: (209) 468-3420 <br /> ENVIRONMENTP LHEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATIONT <br /> �p 13USINESSIAGENCY: 1 '15-03 1 <br /> APPLICANT: � t X10.. `-'" ` ��^ J- „' <br /> ADDRESS: Jif ULI�Sfi SOhvt Q/ °-11 CITYISTATEIZIP: <br /> PHONE (2): FACSIMILE: �" <br /> PHONE(1): X110 x�8 Time: <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from dato of application submittal-'T EQUEST PROCESSED IN 3 BUSINFSS DAYS <br /> r_1 CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH 0 HECKONLY) <br /> - DATE <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List[] Map-Description: <br /> END USE ONLY <br /> FILE ADDRESS Unit 1 <br /> U� Straet0 Street Name city <br /> LOYTn��L�r� - <br /> —1!J ❑Unit 2 <br /> 3. El Unit { f <br /> 4. <br /> 5- unit4 <br /> 6. <br /> T, Unit S <br /> 8. <br /> g. ❑ Unit 6 <br /> 10. to <br /> Specific Date Range of Information Reque3ted: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FAC LTYNEHICLE un,17J <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) QMEDICAL WASTE FACILITY HOUSIN ❑1NASTETIRE � hikLS -lei ABATEMENT <br /> In OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY Q DAIRY K. <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) CHICKEN FACILITY <br /> DOG KENNEL C]WASTEWATER TREATMENT PLANT <br /> ABOVEGROUND TANK A90TELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑❑MOTELJHO ❑LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY ❑COCUSP TIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> ❑TATTOOIBODY PIERCING <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY the li 8:ab above <br /> by hec(EXCLUDING <br /> ng the appropriate <br /> alte YS <br /> 1, ist uo to tem®s in the space above. Select the typa(s)of files from the Io%ia above by <br /> renges)wll notsbe accepted-for additional assistance with file addresses,cont138 or ail act the EHD gApplicationsbreceived afters <br /> 3:00 pm will be processed the next business day. ten 10 <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 2. The EHD will notify the applicant If any EHD files exist, An appointment for review will be confirmed approximately <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. Anew application may e <br /> submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorgan ' <br /> ized by EHD staff at theXEIexpense i LJ <br /> the applicant <br /> •BOXED AREA-EHUSE ON <br /> Future file views by the same applicant may require a$125 deposit prior to review. y.�.. .�.._ <br /> UAL <br /> C <br /> ❑Records provided by Staff-PPR Complete. Staff Name: 914 2- <br /> Rec� Ired Ilme Jan. /. 2013 1 :58PM No. 2033 <br />