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0711912012 08:24 Advanced GeoEnviromental Inc. <br />i <br />I <br />6 <br />)209 4671118 <br />IM I SAN JOAQUIN COUNTY <br />NT <br />iii JILL 19 2012 ENVIRONN ENTAL HEALTa DEPART1v F <br />Telepb�o>0e: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />EI1 PONMENTA1 <br />HF <br />PERMIT/SERVICES PLIC RECORDS RELEASE APPLICATION <br />APPLICANT: W t ( <br />ADDRESS: <br />BUSINESS/AGENCY: , <br />- e I <br />P.0011001 <br />EHD LOG NUMBER <br />3► <br />PHONE (1): / `" ` ep la _ _ __ PHONE (2): , FACSIMILE: 07 11/4y C13 <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - `%nfetive only - must be confirmed) <br />13 CHECK BOX TO EXPEDITE REQUEST -$98.00 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 USIN/ ESS DAYS <br />SIGNATURE OF APPLICANT 0 W DATE l <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street 0 <br />Street Name <br />city <br />Ed Unit 1 <br />1. <br />e l <br />2 <br />Unit 2 O <br />3. <br />Unit 3 <br />e <br />4. <br />5' <br />' Unit 4 <br />� <br />. <br />pUnit <br />6. <br />7• <br />` <br />5 <br />Unit <br />10, <br />Specific Date Range of information Requested: From A(.r r to 4::k <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) eefHOUSINO ABATEMENT 6 OLID WASTE FACILITY/VEHic <br />OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY WASTE TIRE <br />0 NDEROROUND TANK (MONITOWNGfREMOVAL) 0 DOG KEiNNEL DAIRY <br />, HAZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br />0 TATTOO/13ODY PIERCING 0 POOUS(A R - D USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY �UTHER PLEASE SPECIFY) ' <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM -EXCLUDING HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type(s) of flies from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 484-0138 or mail to the address Indicated above. Address <br />ranges will not be accepted — for additional assistance with file addresses, contact the FHD. Applications 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 (10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <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 by the same applicant may require a $98.00 deposit prior to review. <br />EHD U3E ONLY <br />If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br />Received Time—Jul, 19.-2012— 8:21AM—No.059 <br />Aq, <br />