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26/2011 15:17 2033338303 LODI DOWNSTAIRS PAGE 02102 <br /> FIppgNED EHD LOG NUMBER ; <br /> CEIVED SAN JOAQUIN COUNTY <br /> MAY 31 Zo" ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, StO&10111, CA 95202-3029 <br /> ENVIRONMENTAL.HM:ffiephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERMITISERVIC£S <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> . IduSINESSIAGENCY: NOA <br /> APPLICANT; _Ijoa E' q�r24 <br /> ADDRESS. lal cel ---- GltylStatelZip <br /> PHONE(1}: �� PHONE(2) FACSIMI1wF: ?O -1 +� <br /> TENTATIVE*APPOINTMENT DATE: Plecise call Tlme: <br /> - <br /> (Planse allow 10 business days from bate of applicatlon submittal-*Tontativo only-must be confirmed) <br /> 11CHECK BOK TO EXPEDITIE REQUEST-$105 FEE(CASH OR CHECK Ow-Y)-REQuiasi'PROCESSED IN 3 BUSINESS DAYS <br /> r DATE 5-26-11 <br /> SIGNATURE OF APPLICANT — <br /> Electronic Information: [] List(] Map—Description: <br /> FILE ADDRESS - EHD USE ONLY — <br /> Slreeti# j11r1,2nn <br /> /Street Name _ City Unit 1 <br /> - 1,96D1oad e04& 548 (0..-- <br /> Unit-- <br /> Unit 2 <br /> 2. 20719Road Escalon <br /> 3 20963Road, EScalon - --- unit 3 <br /> 4_ <br /> 5. -- Unit4 <br /> —7'.-- — ❑ Unit5 } <br /> - --- Unit 6 r <br /> Specific Date Range of Information Requested.From to <br /> ENVIRONMIwNTAL HEALTH DEPARTMENT FILES <br /> C7 HOUstNo AsASOLID WASTE FACILITYIVrHICLE <br /> XUNDERGROUNQ TANK(U57)CLEANUP SITE(LOP) TFMENT �I`D WASTE TIRE <br /> XOTWER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY <br /> Q DOG FENNEL DAIRY <br /> UNDERGROUND YANK(MONIrOR1NGIREMOVAL) C CHICKEN RANCH 4UAG7rwATER TREATMENT PLANT <br /> HA7ARDDUS WA,97E GENERATOR ©MOTELI!HOTEL PUMPER TRUCKfYARnICHEM TOILETS <br /> TIERED PERMITTED FACILITY LAND USE APPLICATION Sn'ss <br /> ❑TATTOOISODY PIERCING la P44LlSPA <br /> 0 MEDICAL WASTE FAGIUTY ©OTHER(PLFASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ASCE AVAILABLE FOR REVIEW- MoNvAY-FRIDAY 8:00 AM-S:UOPM - 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 209 464-0 3B or mail to the address Indicated-above.- Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The FHD will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten(10} <br /> days after Ircelpt 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. Anew 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 rvviCwn by the same applicant may require a$105 deposit prior to revievi. <br /> EHD USE ONLY <br /> I _ <br /> �' EHD 4$-68 $l041c17 PUBLIC RECORDS RELEASE APP FORM <br /> I <br />