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SIERRA DELTA CONSULT NAIL sus'rel <br /> a2/02/2012 10: 81 8052399309 <br /> R rt C EIVE® EHD LOG NUM80 <br /> SAN JbAQUIN COUNTY <br />. FEB 0 7012 ENVIRONMENTAL WEALTH DEPARTMENT <br /> 0 <br /> 600 East Main SLZtockton C 5202-3029 l <br /> Tel�epphone: (209)468-3.420 Fax' )454-0138 b: www.sigov.org/end <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC""RECORDS RELEASE APPLICATION <br /> APPLICANT: d �. I3USINESSIAGENCY: - <br /> ADDRESS: � ;k7. CITYISTATEIZIP: ati5c ';;2 _46 <br /> PHONE (1): '�, '� PHONE(2):__ _ _ FACSIMILE:q,o5.Z.^?jn <br /> TENTATIVE'APPO INTMENT"DATE: Time:. <br /> (PIOQe allow 14 busincss days from date"of appilualion submittal-*Tenterrve only-mum be canflrmed) <br /> Cl CHECK BOX TO EXF`FDITE,REOUEST-$125 FEE(CASH OR CHECK ON1 Y)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2 2. <br /> Electronic Information; ❑List ap--Description-, <br /> l <br /> FILE ADDRESS END USE ONLY <br /> Strout if Street Ne Me ' City <br /> UnH1 <br /> 2. <br /> d •at <br /> 4. <br /> 5 unit3 <br /> i <br /> 7. 1715 a .�_ Unita. <br /> g, Unit 5" <br /> 9fl. <br /> Specific Oat@ Range of Igformstion 0equvated: From Unit 6 <br /> ENMI20NMENTAL"HEALTH DEPARTMENT FILES to <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C]HOUSING ABATEMENT ❑SoLIF WASTE FACrLrTYiVEMCLE <br /> ®OTHER CLEANUP SITE(NON-LOP) <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) El FOOD DOC KENNEL- ❑WASTE TIRE <br /> ❑ NNI:k. El DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> I TIERED PERMITTED FACtLrTy ❑WASTEWATER TREATMENT PLANT <br /> ❑MOTELli10TEl❑ ❑PUMPER TRUCKNARDICHEMICAL TMLEFS TATT001$ppY PIERCING . Q PO01APA ❑LAND USE APPLICAMN SITES <br /> C. . ❑ <br /> MEDICAL WASTE FACIIiFY ❑COMPLAINT RECORDS OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:04 AM-5:00PM EXCLUDING HOLIDAY <br /> LiS) <br /> 1, st_up to ten addresses In the space above. Select the type(p)of files from the list above by Checking the appropriate <br /> box(as). At least one file type MUST be selected: F x 09 0 or II he d I to 0 <br /> ranges Will not be accepted-far additional assistance with file addresses,contact the EHD. Addrtsss <br /> 3:00 prn will be procesaed the next business day. Applications received after <br /> 2, The EHD will notify the applicant If any EHD files exist. An.appointment.for review will be confirmed appro.xlrnately ton(10) <br /> days after receipt of application. The files will be held for a maximum of five business days far review. <br /> should be scheduled accordingly. Appointments <br /> 3. A file that is actively being worked ori by EHD staff may not be immediately available for <br /> submitted when the rewlsw. Anew application may be <br /> file is available. <br /> 4. Any file not returned in the same condition es released will be reorgankrid by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant'may rMQulra a.$125 deposit prlor."to review, . <br /> CND USE ONLY <br /> E}Ip IHAB <br /> - anhT <br />