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DATt t ��JVE , 1{ SAN TOAQUIN COUNTY EHDLOGNUMBER <br /> ENVIRONMENTAL HEALTII DEPARt, Stoddon, CA TME <br /> AU fi 2 Zp07 600 EastTe�'ap hone: (209)4683 0 Faxain !(209)464-0138 Web: www sjgo 677 <br /> ENVIRONMENT HEAT IW <br /> PERMIT/SERVICEESPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: y&Lj 1( 6_ (l,l' enit y __ _ BUSINESS/AGENCY: 51C�?_1'a beA4A CORP. <br /> ADDRESS: S 0;�L <br /> PHONE(1): .a.5%• Z2.S PHONE(2): FACSIMILE: SSY Z-29./1167Z_ <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Pleeae allow 0 business days from date of applinatlon submittal-'Tearsdve only-must be Confirmed) <br /> O CHECK BOX TO EXPEDITE.REGVFST- 28. OF ( H CHECK ONLY),MOLEST PROCESSED IN B BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Fc-Z. -O--i" <br /> Electronic Information: []List❑ Map-Desai on: <br /> FILE ADDRESS EHD USE ONLY <br /> k Street a Street Name City D � ; j4") <a t ❑ Unit <br /> b 1. IN9� HIC*VWA`i 258 LDD l <br /> 2• GAAFx SIDE IUWI by4Ji' ❑ Unit <br /> 6V jr <br /> 3. <br /> (� 4, til <br /> Units <br /> 8. <br /> T. <br /> ❑ unit e <br /> 8. <br /> 9. <br /> Units <br /> 1 D. <br /> Specific Data Range of Information Requested:From /99 y to 'Prt.E SGNIT <br /> y ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> /9 UNDAROROUND TANK(VST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT �A1M,.��I SOLID WASTE FACILrTYNEHICLE <br /> OTHER CLEANUP SITE.(Now{OP) fO�FnO�OnD FACILITY PWASTE.TIRE. <br /> UNDERGROUND TANK(MONITORING/IREMOVAL) C3DOO KENNRL 13 DAIRY <br /> HAZARDOUS WASTE OERERATOR 13 CHICKEN RANCH IT WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C MOMLIHOrPL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> Ci TATTOO/BODY PIERCING O POCUSPA ❑LANG USe APPLICATION SITES <br /> 17 MEWCAL WASTE FACILITY C3 OTKER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FRIDAYO:00AMd:DaPM EXCLUDINGHOLIDAYS. <br /> 1, Ust up to ban addresses in the space above. Select the typa(s)of flies from the list above by Checking the appropriate <br /> box(az} At least one file type MUST be selactad. Fax to(?091464-0198 or mall to the address Indicated above. Address <br /> ranges will not be aecapted-for additional assistance with file addresses,contact the END.Applications received after <br /> 8:00 pm will be processed the next business day. <br /> 2. The END Will notify the applicant If any END flies exist An appointment for review will be confirmed approximately ten(10) <br /> days Nffir reeelpt of appllcAtIon. The ices Will behold for a maximum of Ave bush■ssdays for review. Appointments <br /> should be scheduled accordingly. <br /> 8. A file gut Is Actively being worked on by END atAff may not be Immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any fila not returned In tha same condition as released will be reorganized by END staff at the expense of the Applicant <br /> Future file reviews by the some applicant may require a 498.00 deposit prior to review. <br /> END USE ONLY <br /> END-49Ma 7 <br /> 1 'd ZSbT-6ZZ-6SS- T d.1oO ezlaU e.I�azs dIZ :EO LO o2 5nil <br />