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Ffeh. 2.. 20.16 1 :49'PM No; 2355 P. 2 <br /> DAT EHD LOG NUMBED <br /> R"ECENED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTME' N'T <br /> 1-868-East-llazeton-Avenue�iack#on,�A-952(,5-6232 <br /> = ov.Telephone, (209)4683420 Fac: (209) 464-0138 Web'- www.sjgov.org/�'ehd <br /> t <br /> EWRONMfWt-.KTAL HEALM-§ <br /> RLarsERVICES PUBLIC RECORDS 'RELEASE APPLICATION <br /> APPLICANT: . (U9 11/7;1 jS BUSINESSIAGENCY: s,TCOVAAr f 040 Wo <br /> ADDRESS:R . <br /> IiY1STAT Eli P: <br /> PHONE (1): PI{ONE(2): FAX OR <br /> please allow 10 business days from date of application submittal For the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested record,5. <br /> CFfECKBOX.TO EXPEDITE REQUEST-$t30 FEE CASH OR CHECK 011L1`)YREQUEST PROCESSED[N 3BUSINESS DAYS <br /> „. _..__ ......_—.... <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: 0 List 0 Map—Description: <br /> FILE ADDRESS <br /> Street# Street Mame City <br /> EHa USE ONLY <br /> �• �OD0U <br /> 2. 0 l C20 Sr W nacy <br /> Unit <br /> 3. 305C j ,A10 4415 <br /> �© � <br /> ®unit z <br /> Q. Aja L{p r ys� ' i�- r J w� !mac ft I7'0 Unit ZH - _0 <br /> L�unit3 r <br /> a• ` <br /> —TrA fMVd fVQ nit 3FfM <br /> r 7. f2IQZ <br /> 0 [D Unit 4 <br /> Q S f5(Vd ��� IIT r TION <br /> a <br /> L19 <br /> " �S Tl 0 Iva <br /> r V4 • a �� ©�n it 5 <br /> f i [ L V st E <br /> Spaclflc Data RenOe of Information Requested: From to 0� <br /> to fftuhMi"EN,T"Al HEALTH DEI'Fik���Vlif=f+fTFILES <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LAP) .- []MOTEL/HOTEL r <br /> �THER CLEANUP SITE(IJON-f_OP} [ SOLID WASTE FACIL[ HI <br /> ( R1fOUSINGABATEMENT 1 <br /> aUNDERGROUND TANK MoNITORINGIREMOVAL)� [WASTE TIItE ❑FAIR FACILITY <br /> ErAvovEGROUNO TANKO( itHICKEN iZANCHI DOG KENNEL DAIRY,Poo115PA <br /> HAZARDOUS�1i1ASTId fX r WASTE1NATER TWATWIENT PLANT <br /> Q-HAZARDOUS MATERIALS 0 MEDICAL WASTE FACILITY [R?UM ER TRVCK1YARD/CHEMICALTOILEfs <br /> [TIERED PERMITTED f Acl tr U� ❑TATTOO/EDDY PIERCING E?- AND USE APPLICATION SITES <br /> Q'COMPLAINTIREBPONSE RECORDS Q OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT}RECORDS ARE AvAfLA13LE FOR REVIEW: MONDAY-FRIDAY S.00 AIN-5:ooPM ExCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s),of fifes from the list abova by checking the appropriate <br /> box(es). At feast one file type MUST be selected, Fax to 205 484-0138 or mail to the address indicated above. Addmss <br /> ranges will not be accepted.Applications received after3:00pm will be processed the next.business day. <br /> 2. For assistance in identifying the nature and.content of EHD records, please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if Any EHD files exist. Ain appointment for review will be confirmed approximately ten(10) <br /> days atter receipt of application. The:Frfes will be heid for a maximum of give Business clays for review_ Appointments <br /> should be schaduled accordingly. <br /> 4. Any fife not resumed In the same condition as released wlil be reorganized by EHD staff at the expense of the applicant. <br /> Future fife reviews by the same applicant may require a$130 deposit prior to review. <br /> —BOXED AREA-EHD'USE ONLY**' <br /> -7—1 <br /> ►Sd� 6_ fso co I���� � sr �7r I � t .5101 07 <br /> Received Ti7 HF b. 2. =2016- 1 ;44PM=No. 0434' <br />