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-za4-nsso Line 11 .Uo.m. 10-23-2012 l /l <br /> DATE cnDLOG NUM <br /> SAN =OAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL E���� ��� <br /> � n � <br /> ~^ <br /> 1O68East Hazelton Avanua` GtocktoD N x <br /> �[ | � � ��13 . <br /> = � ~K��ep�ome: /209\ 488-3420 Fax: (209)454'0138VVeb: -v.org/ehd m/ <br /> EWBON88E&TAL � <br /> PERMIT/SERVICES--'- <br /> --~ ���� k�� ��������K�� RELEASE APPLICATION <br /> PUBLIC ^^~-~~~~^~~~~~ ^~^-^-~-"~^~~~ ^ ^^ ^ ~-^~~^^^ ^~~^~ <br /> APPLICANT: /�/�*�� /_������J�' BUSINESS/AGENCY: <br /> y,��2~ <br /> ADDRESS: / ��77 /��'���� ��z���' ��r���� C|TY/STATE/Z|P: �� <br /> PHONE/ R�NE (2 � �� - FACS|M|LE: ~ -#�s5p <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> F-1CHECK BOX T0EXPEDITE R F H0 CHECK ONLY) REQUEST PROCESSED|NoBUSINESS <br /> SlC�NATUE�E {�F�\PPL|C�\NT ��a����p ----- 0ATE , <br /> U <br /> Electronic Information: �� List K8a' -Oeaor|pt|on' U <br /> � �� �� p ' K <br /> FILE ADDRESS sHoUSE ONLY <br /> nunct 9 Street Name cih' []Unit 1 <br /> 1. 0137 6n 2. C7a / b > �T/Cldll�~5�-~ / Unit <br /> 3- <br /> // <br /> . /��� �� . �»,�/ // ~5�7^~ / �] \ � El Unit ^ <br /> L/- 5_ /i/�/ <br /> ' ~ <br /> G <br /> ~[]Unit* <br /> 7' <br /> 8. <br /> []Unit n <br /> y. , /~ <br /> K/[ ƒ~ ( u/�/ �//7 <br /> �O. >' ~~ '~=~// �'6 `0 / []'Un|ts <br /> Specific Date Range v,Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> VNDERGROUNo TANK(UST)CLEANUP SITE(LOP) ----El H0u8wG AaoTsMcmn '-'------' SnuoVVx§ft ------ <br /> FOOD FACILITY WASTE TIRE <br /> VLUNDERGROUND TANK S/RcMnvxL) DOG KENNEL DAIRY <br /> rRHAZARDOUS WASTE GENERATOR F1 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> T|cncoPERMITTED FACILITY Mu7cUHoTcL El PUMPER TRocxy/Anm%xcM|cxLTOILETS <br /> ' T*TrOo/BUovP|scC/xn F1 PooUSpx LAND USE APPLICATION SITES <br /> �] <br /> MEDICAL WASTE FACILITY E]COMPLAINT RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELLAmD SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY O:OO&M'5:UOP�(ExoLVo|NoHouoAYa) <br /> 1. List Liatoouoten addresses inthe space above. Select the (s)offiles from the list above bychecking the appropriate <br /> box(ey). At least one file type MUST beselected. Fax u,(uoy)4G4~0138ormail tothe address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after <br /> 3:VVpmwill buprocessed the next business day. <br /> n. The EHDwill notify the applicant ifany EHDfiles exist. Anappointment for review will beconfirmed approximately ten (1V) <br /> days after receipt ofapplication. The files will beheld for amaximum offive business days for review. Appointments <br /> should hwscheduled 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$125 deposit prior to review. <br /> | soov�sowa | <br /> / / <br /> | | <br /> | | <br /> | | <br /> i / <br /> Received Timo-0ct. 23. -2012-11 : 26AM-No. 1470 unn, <br />