Laserfiche WebLink
0 <br />1234 KLEINFELDER '3:14 06-29-2010 1/1 <br />GATE RECEIVED EH LOG NUMBE <br />� SAA IN COUNTY <br />1 0NMENTA4 , EALTH DEPARTMENT <br />East a� in'St. 4 ckton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/eh <br />PUBLIC RECORDS RELEASE APPLICATION <br />- <br />ADDRESS: <br />CITY/STATEZIP <br />E NCY: <br />PHONE (1): 05 - PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days fr date of a Ilcation submittal -'Tentative only - must be confirmed) <br />HECK BOX TO EXPEDITE REQUEST - $1 5. 0 EE (C OR C CK ONLY)- REQUEST PROCESSED IN 3 BUSINE S DAYS <br />SIGNATURE OF APPLICANT DATE X010 <br />11 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />to <br />Street ak <br />Street Name_ <br />_ <br />City Th C' nit 1 <br />t P �� <br />iun� ©�rj , rG Unit 2 <br />Unit 3 <br />, Unit 4 <br />w Unit 5 <br />u� V, ..� I,n <br />-- Unit 6 <br />,. <br />2. J <br />�Q a <br />'l� <br />- - <br />- �� <br />3. <br />4. <br />.+� SOLID WASTE FACILITY/VEHICLE <br />� 1 -- - <br />5. <br />6, <br />7. <br />Q WASTE TIRE <br />❑ DAIRY <br />t i ►�y <br />W <br />❑ CHICKEN RANCH <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL <br />8 <br />0 TATTOOIBODY PIERCING 0 POOLISPA <br />4. <br />O MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY) <br />i 0. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br />Specific Date Range of Information Requested: From - (�'�ACtC <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />;2 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />.+� SOLID WASTE FACILITY/VEHICLE <br />MOTHER CLEANUP SITE (NON -LOP) ❑FOOD FACILITY <br />0:9P_ DERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL <br />ET HAZARDOUS WASTE GENERATOR <br />Q WASTE TIRE <br />❑ DAIRY <br />t i ►�y <br />W <br />❑ CHICKEN RANCH <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL <br />OVASTEWATER TREATMENT PLANT <br />0 TATTOOIBODY PIERCING 0 POOLISPA <br />❑ PUMPER TRUCK/YARDICHEM TOILETS <br />0 -CND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the address Indicated above Address <br />ranges will not be accepted -for additional asslsta��tt Ile 4id7) es, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day, A <br />2. The EHD will notify the applicant If any EHD files exist jAn 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 $105.00 deposit prior to review. <br />EHD USE ONLY <br />***If you need further assistance please contact Diane Martinez @ (20911 .)468-3425 direct) Thank You*** <br />_0 AAA) '1i0_ 101 D/Y/11/U /ils2 Cum <br />- -�� • (OVVf ` -�_. _ 1 rawV y�i7 nt7C7(� �O� �il� d- <br />P - uYYlplav'14- � T� � <br />EHO 1-i io. Pro-J,a a `OPye f(o 3K 1 FNS o�d tuooSy�� quus�o( � <br />