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DATE RECEfVED <br /> EHD LOG NUMBr-_Z <br /> SAN JOr QUiN COUNTY <br />;IRECEIVED & 1IRONMENTAL HE <br /> ALTN DEPART14T <br /> 600 East Main St_ Storkton, CA 95202-3028 <br /> S E P 2 7 20Tl�'IePh0ne: (209)468-3420 fr-ax: (209)1464 138 Web: www..5jgaV.orglt3hfd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> AAI3Lre✓ANr; ,t C SUSINESSIAGENCY: 1.�✓G c. - eo ,,tl q r►+y� <br /> ADDRESS: 0'} �. C� � . CITYISTA,TE/ZIP: <br /> i PHONE(1): PHONE M:� FACSIMILE: ��- <br /> TENTATIVEAPPOINTMENT DAl lead a! _ l <br /> 0 -- Time: <br /> (PllovR ZO business daNs from date of$I irafion suhmirtlaf_"W <br /> Ten[arive only-must Ise eor►firnned) <br /> ❑CHECK sox TO EXPEDITE i2EQUF=sr- 125FEE( H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t <br /> Mill 1 <br /> --.� <br /> Electronic lnfornation: [I List E] Map_Description: m <br /> FILE ADDRESS Eula USE ONLY <br /> street# street Name cit <br /> � <br /> 3 4. <br /> 10)5Ii J <br /> 7. „ft4 <br /> s. muni 6 <br /> 10. <br /> ©unit s / <br /> SPeciTicDaae Raga of InforrnaWn Requested; From to <br /> EWRONMENTAL HEALTH DEPARTMENT FILES <br /> IN UkI3ERGROUN[t TANK((!ST)CLE;AfaUP SrCE(LOP) ❑HOUMNG AsAT 11EAr ❑SOLID WASTE FAcILummICLE <br /> f GTOLk CLEAwP SmE(WON-LOP) ❑FOOD FAC4m <br /> UNDERGR UNO TANK(M0NrTORtWJFi ffmwwAL) ❑000 KEWAEL Q WASTE TIRE <br /> HAZARDOUS WASTE_GENERATOR ©O•�v <br /> ❑CHfCfCEH RA�Cfi ❑W,4sTIFfIIATER TRF.AITitIW PLwrr <br /> TIE"RCo PERMITTED FACILITY <br /> ❑:MOTELIIIpTEL [j PUAEPi=R TRGCKdYARD1CFiEiIIAt TOfLEfS <br /> TATTOO/BODY PIERCENp ❑POot1SPA ❑LAND UsE APP CAMN SATES <br /> ❑ MEDICAL WASTE FACE ITY ❑ComPLArNT RFwRj)s ❑GYIIER(IyLEAm <br /> WELL AND SEPTIC PERIIfNT WCORDS AW AYAILASLE FOR I'EUIEW: MONDAY-FRIDAY 8:00 AV-5:00PM(EXcLuom HOLIDAYS <br /> 1• LW UR 12 Ito 00dresses in the$pace above_ Select the type(s)of files from the lis v <br /> bvx es . At leant <br /> tY ( ? t above by eltsacJting the a(aproprlate <br /> ( ) one file type MUST be seHacted. 464-0136 or mall.to rile edreas jnqiVe. Address <br /> ranges will not be accepted-for additional asuistance with file addresses,contact the EHD, APP recelveci afiber <br /> 3:44 Orn wlEi tie pr�gcaass3srd the next bspstr lay. <br /> 2. The EHD vnlr notify the applicant If any EHD files exist. An appointrmnt for review will be confirmed approximately ten(14) <br /> days aiftar receipt of appNcatiorr. The fifes VAII be held for a maximum of Five business days for review. Appointment$ <br /> should be scheduled accordingly. <br /> 3. A flle that ft actively being worked on by END-staff.may not be immediatvly available for review. A new application#Ve»ky be <br /> submitted when the file is available_ <br /> 4. Any file not returned in the same,condition as released Mrifi be reorganized by END s#aff at the expense of the applicant. <br /> Future Fie reviraw� by the same applicant may mcluim a$125 deposit prior to review. <br /> FH)USE 04�Y <br /> "O 4a <br /> VIM <br />