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Dec 09 09 12: 20p Krazan & Associates 559348P' 90 p. 1 <br /> RMIMEO SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPA <br /> WEC 0 9 H09 600 East Main eet, Stockto 2 � f <br /> _ M T hone: 209 468-34J9 <br /> 209 464- www.s ov.or <br /> ENVIRONMENT HEA 7, <br /> PERMITISERVICES PUBLIC RECORD ,EASE APPLICATION 4 ? U <br /> APPLICANT: v- `� BUSINESS/AGENCY: t;pn ITw .f QG cam' <br /> ADDRESS: I i 1J. rTL�� �y^, ` <br /> � I to/zip S:L-O'J Is <br /> PHONE(1): 3 L4 S- 2-avo PHONE(2): � h <br /> •�' FACSIMILE: � •_-'�L{� -�.��� <br /> TENTATIVE'APPOINTMENT DATE:M(_') Time: <br /> (Please allow 10 business days from date of applicgtion submittal-`Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-5 5 F . (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map– Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name City <br /> Unit 1 <br /> 2. <br /> 3. 1� �� °I t I \� <br /> v 4. ���� iI 1. o? unit3 <br /> 5. <br /> WI <br /> D-9 -- <br /> 6. - - - - �lnit 4 <br /> 7. -- - -- ---- � - <br /> 8 _- - El Unit 5 <br /> 9. <br /> 10. — Unit6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH.L &RTMENT FILES <br /> J�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT p$OLID WASTE FACILITYNEHICLE V J 0 <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY WASTE TIRE�RI <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY ws• 'n/ (��/ <br /> Js HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILIT - \ ❑MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> *9 MEDICAL WASTE FACILITY ❑OTHER(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 files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with rile addresses,contact the EHD. 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />