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SEP. 21. 2001 2: 12PM rnkDOR EARTH TECH N0. 4861 P. 1 <br /> DATEU U CE E 5 � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> LNED <br /> �J EN11 East Main <br /> SIAL HEALTH DEPARTMENT �e� <br /> SEP 2 1 200 . 600 Bast MauD Street,StocktoD,CA 95202-3029 <br /> elepholle;(209)468-3420 Fax:(209)464.0138 Web:www.sjgov. <br /> ENViRONMEN f E&LT$UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a 50 j� C DYJ Q./ ' BUSINESSIAGENCY: oho/ E' o/Cly pS' <br /> ADDRESS: fa/1 K C,rCT U,' <br /> PHONE(1): '2 Q 2u—ti PHONE(2): FACSIMILE: — J1"✓7 p <br /> TENTATNE•APPOINTMENTDATE: C/C fo e� �i Time: �0 <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) ' <br /> ❑ CHECK BOX TO EXPEDITE REQUES 98.00 FFE(CASH OR CH LY)-REgU CESSED IN 3 BUSNESS D YS <br /> SIGNATURE OFAPPLICANT DATE 9 <br /> Electroniclnfortnation: ❑Map—Description <br /> a FILE ADDRESS EHD ONLY <br /> streqeet#q �^ Street Name city of -I 7 of j Unita <br /> IX G CCS �1 be/' c io fC4 <br /> \� 2. -f J� /7 V r'or ct7LJ OC 7Im b Until <br /> CJ <br /> DY-- chmi, e 1 -5- S-Me7'a � j L L <br /> l <br /> Q? N n do kilo <br /> a v w '� � 7 <br /> oILr6. l � Gran 5 ounxa)�f 5 �1! fidcx u oIuDit6 0 -5 ><aa -1 none Q Unit <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> k"MIRDOUS <br /> RGROUND TANN(UST)CLEANUP SIM(LOP) ❑HOUSING ABATEMENT �SOUD WASTE FACILITYNE E <br /> R CLEANUP SITE(NON-LOP) In FOOD FACILITY 11 WASTE TIRE 'r . <br /> RGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL O DAIRY <br /> WASTE GENERATOR M CHICKEN RANCH ❑WASTEWATER TREATMENT 4 1 <br /> TIERED PERMITTED FACILn ❑MOTELIHOTEL 13PUMPER TRUCWYMD/CHEM <br /> O TATTOOBOeY PIERCING O 14 POOLISPA LAND USE APPLICATION Srr s <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-s:OOPM -ExcLuo NG HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Sel&the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be Sell c6d. Fir to 12091464-0138 or the <br /> to the address indicated above. Address <br /> ranges will not be accepted foradd 7assistarf a with de addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next i �-s day. <br /> 2. The EHD will notify the applicant Hb-files exist ant for review will be confirmed approximately ten(10) <br /> days after receipt of applicatio will be held for a U Ve business days for review. Appointments <br /> should be scheduled accordin ti <br /> 3. A file that is actively being wor�ton by EHD staff may not be immer4�gl a b for review. Anew application may be <br /> submitted when the file is available. yy <br /> 4. Any file not returned in the same condition as released will be reorganized by 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 USE ONLY <br /> EHD 4a WEB SWDOI <br />