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jan. 13. 2014 1 :29FM No. 0860 P. 1
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<br /> V E (� i` EHO LOG I(1MBER
<br /> ON RIILE�� SAN.10AQUIN COUNTY �•..,,� �y�
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> JAN 13 2014 1868 East Hazefton Avenue,Stocktbri, CA 95205-8232
<br /> . Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd
<br /> ENVIRONMENTAL HEALTH
<br /> PERMIT/SERVICES PUBLIC RECORDS RELEASe- APPLICATION r
<br /> APPLICANT: ifs, t,/ W lne..(e1 BUSINESS/AGENCY: S o
<br /> ADDRESS: LT 3 3 15 54yk+' t-itY1STATE/7JP--. Haxw.M ,-a6 l k d Yl
<br /> PRONE(1):• T1.%Q , PHONI°9):(0:10 AN Z,•q 5815 FACSIMILE:&10)-f(g,-.T3 y9
<br /> TENTATIVE`APPOINTMENT BATE: 111b11,4 Time: /•(1U _in
<br /> (Please allow 10 business days from appitcatlan au m l-'Innudye only-muat be confirmed
<br /> CHECK BOX TO EXPEDITE REQUEST-6126 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT. DATE I&A Q/r3
<br /> Electronle Information: p List❑Map—Description-,
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<br /> Specific Date Range of Information Requested: From All to
<br /> ENVIRONMENTAL HEALTH DEPARTMENT PILLS
<br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WA8TE FACILITY SOLID WASTE FACILTIYNEAICLE I���.
<br /> OTHER CLEANUP SITE(NoN•LOP) HOUSING ABATEMENT W
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<br /> Asm TIRE
<br /> UNDERGROUND TANK(MONITORINGIREMI)VAL) FOOD FACILITY DAIRY 1,1
<br /> AeOVEOROUND TANK CHICKEN RANCHI Dos MNNEL WAM tVATER TREATMENT PLANT
<br /> HAZARDOUS WA9TRjH�7ARD Dub MATERIALS HimoTWHOrrm PUMPER T=KIYARDICHEMICAL TOILETS
<br /> TIc;;Eo PERMITTED FACILITY ElPOOLISPA LAND UBEAPPLICATION SITIM
<br /> ir.TTOOIBODY PIERCING Dg COMPLAWI MSPONfli RECORD11 OTHER(PLEASE SPECIFY)
<br /> WELL AND SEPTIC PERMIT REcOK02 ARE AVAILABLE E'Ok REVIEW: Mo4p. .1°RIDAY 8:00 AM-5:00em(ExCLUDINO Hot.ws)
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<br /> 1. List up to)Qn addresaea In the space above. Select the type(s)of fll4o from the flat above by checking the appropriate
<br /> box(es). At least one file type MUST be selected. Fax to(?Q91464.0948 or mall to the address IndIrAj2d Above. Address
<br /> :±ages will not be accepted-for additional assistance with file addrd ifisa,contact the RHD. Applications reeelved after
<br /> ::4 pm will be processed the next business day.
<br /> 2, u EHD will notify the applicant If any RHD files exist An appolnWidt for review,will be confirmed approximately tan(10)
<br /> ;Is after receipt of application. The fifes will be held for a maxlmurh 6f flve bualnese days for review, Appointments
<br /> Auld be scheduled accordingly.
<br /> 3. t,file that Is actively being worked on by END staff may not be Immodiately available for review. A now.application may be
<br /> E+sbmltted when the file Is available.
<br /> 4. f.':--1 rile not retumed In the same condition as released will be reorgenfaed by EHD staff at the expense of the applicant.
<br /> r .:.ire Ilia reviews by the seine applicant may require a$126 deposlt)►iler to review. .�>���ai� d
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<br /> :c4ri1S rovl' s .b :®taff:PPR Coln• Ste`:.stall Name:
<br /> 914112
<br /> Received Time Jan, 13. 2014 1 : 34PM No. 4993
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