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fib. 28. 2005L, 9:0804--0- No. 1391 P. lx Dl <br /> &"1e rMumvrw SAN JOAQUIN COUNTY bnu LLA;ntxnetl <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> +. <br /> ten• r.,..,r_ __ A.:;r'up,3r1 FIvor,Stocktoa,CA 95202.2708 <br /> F tp L 8 9005 Telephone: (209) -469-3420 Far.(209)464-0138 Web-,wnvwajgov.org/chd ' � I <br /> ENVIRONhSENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> R&RI414eWA46€9 <br /> APPLICANT: WA`YTM514 4,A;v+(4N.�" 13USINESWAGENCY: MILE tJI1 ,pQ,1M1S1.lL tJi <br /> ADDRESS:I L4 I I S iRi MIPAtA AVT- 5r—(45 '104 " /6-R-oN - C4 4Ya0874) <br /> PHONE(1):_q'3I-R9 9-I 1 A'I PHONE MI: FACSIMILE-' q 5 l-OaR^(I C <br /> TENTATIVE*APPOINTMENT DATE: —I•CO PM <br /> (Plaaea allow 10 business days from date of application subminal--renfaNve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$03.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,�ysa ��— DATE <br /> UNIT DISTRISUTION 0 Unit 1 O Unit R 9�0 nit 4 ❑ Unit 6 13 Una 8 ❑ Other(alach0 IdUstsimaps) <br /> -11 <br /> FILE ADDRESS SE ONLY <br /> 9lraata Street Name City <br /> 3. <br /> �NiOO <br /> 4. J <br /> N 5. K <br /> NPF 6. <br /> �tw`lass y, <br /> 8. <br /> 9. <br /> 10. <br /> Specific Data Range of Information Requested:From A-Ila <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES, <br /> U RGROUNOTARK(UST)CLEANUP SITE(LOP) O HOUSING ABAM>; <br /> TONT 0$DUDWASTE FACILnYNEHICLE <br /> �❑ ER CLE~Snr(NON-LOP) ❑F000 FACILRY O WASTE TIRE <br /> 06ROR UNO TANK(MONnORINGIREMOVAL) 0DOC KENNEL 0ONRY <br /> oOus WASTE OOMORAYOR D CNMaffN RANCH D WAM"ATPtt TmATMPNT PLANT <br /> IERED PERMITTSD FACILITY 0MCTEIMOTEL l7 PUMPER TRUGIWAROICWIA TOILET6 <br /> dorl TATTOOIBODY PERGMG D PO"PA ❑LAND USE APPLICATION SITES <br /> D MwICAL WASTE FACILm D OMR(PUNME SPBOIFY)___� U9 <br /> WILL AND SEPTIC PERMIT RECORDS ARE AVARAaLE rOR REVIEW - MTONDAY-PRIDAY 8:00 A94:001`I4 - PXoLUD"H000AY0. <br /> 1. List up to ten addresses In the space above. Select the type($)of files from the list above by checking the <br /> appropriate box(se), At least one file type MUST be selected. Fax to(x091464-0138 or mail to the address <br /> Ir <br /> Indioated above. Address ranges will not be accepted-for additional assistance with file addresses,conlaet <br /> the EHD.Applications received after 3.10 pm will be processed the next business day. Its <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review VIII be confirmed <br /> approximately ten(1 D)days after receipt of applleation. The files Will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that le actively being worked on by END staff may not be immediately available for review. Anew <br /> application may be submitted when the 1110 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 <br /> applioant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> Calc u-maae <br /> t+rzatA <br />