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11/04/2611 14:33 8884443083 PEN PAGE 01/01 <br /> RECEIVED 01 <br /> DATF RFf:FIvFn SAN JOAQUIN COUNTY � EHD LOG NUMaER <br /> V 04 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HFAL7Fil 600 East Main 6t. btookton, LA 95202-3429 <br /> PERMIT/SERVICES Telephone: (209) 468-3420 Fax: (209) 464-6138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEAZjE APPLICATI N f— <br /> r <br /> APPLICANT: row-ell A ���' BUSINESS/AGENCY: A (n;, <br /> ��p I , <br /> ADDRESS.f�rO O VA,, 0 . Y/STATEIZIP: <br /> PHONE(1): /S lQ--5;70 PHONE(2): FACSIMIL,�"g <br /> T TAT/VE`APPOINTM ENT DATE: Time; <br /> (IFlaa'a alloy 10 busine"days f to of applioAGon cub m l "Tonfstivo only-muet bo confirmod) <br /> �J CH=CK SOX TO EXPEDITE REQUES - C O �NLY) REQUEST PROCESSE7 IN 3 BUSIN S 0 8 <br /> SIGNATURE OF APPLICANT 0ATF <br /> Electronic Information; ❑List❑ ap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Streak Na 0 City <br /> URIt! <br /> z. <br /> unit 2 <br /> rr�itu 4. 35 0L(60 I __ unit3 <br /> } � 5 6 a oI t y <br /> w 4 <br /> F. <br /> ❑ Unit's <br /> 10. <br /> alit is <br /> Spoclfle Data Range of Intormation Requested: From to <br /> ENVIRONMENTAL HEALTH DErPARTMENT FILES T <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ©Housim ABATEMENT OLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ASTE TIRE <br /> RLIJNDLRCROU TANK(MowroaINWREMOVAL) ❑Doc K&NNGL lRY <br /> HAZARDOUS WASTE Is ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> iEREO PERMITTED FACILITY [ MOTELIHOTEL El UM' <br /> ER TRUCK/YARDICHEMICAL TOILETS <br /> TATToomoDY PI ERGING ❑POOLISPA LAND USE APPLICATION SITE; <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PEkmrr RECORDS ARE AVAILABLE FOR RE111Ew: MONDAY-FRIDAY B:00 AIS-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List uo to ten address in the space above. Select the type(s)of fuels from the list above by checking the appropriate <br /> box(es). At least one file typo MUST be selected. Fax to 209 464-09138 or mail o he a drass indicatad above. Address <br /> ranges will nat be accepted-for additional asaiatanca with fila addrda=G,contact the EMD. Applloatlonc received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(14) <br /> days after receipt of application. The rales will be held for it maxirnunr of five businbss Mays far rtrviuw. Appointrnerils <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. 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 bV the same appficant may retlalra a$922 deposit prior to review. <br /> EHD unr ONLY <br /> EHD 4846 aTrlarta <br />