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CEtVED 9 <br /> SAN JOAQUIN COUNTY + II iG NUMiIR <br /> MAR 112014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> EN1(IRONMENTALHEAhT 1868 East Hazelton Avenue, Sfockfon, CA 95205-6232 <br /> PERMIT/SERVICE (209)468-3420 Fax: (209)464-0138 Web: Wwwsjgov.or /ehd <br /> 9 (jr <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: o n tiry� i� p BUSINESS/AGENCY: <br /> ADDRESS: C P� / <br /> O s�cITY/STATE/ZIP <br /> PHONE (1): �(��0 3 9 7 PHONE (2): 0 <br /> TENTAT/VE*APPOINTMENT DATE: FACSIMILE: <br /> /d ^/789'6W(,,(Please allow 10 business days from date ofa lication submittal-* Time: <br /> PP Tentative only be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 SH <br /> ONLY)-REQUES OCEBSED IN 3 BUSINESS DAYS <br /> .SIGNATURE OF APPLICAN <br /> DATE -_7 <br /> Electronic information: E] -is Map-Description: <br /> FILE ADDRESS <br /> Street EHD USE ONLY <br /> �^77 Street Name Cit}, <br /> 1• c-ril:J A/ 9.$*f o✓,Le, � iJYt E] Unit 1 <br /> D2 US7 �ocos�d 3 <br /> 2. O —/ O 11iNaO <br /> 3• ❑ Unit <br /> 4. <br /> 5• / l l <br /> ❑/ Unit 3 1 <br /> r <br /> 6, nl`(�7,I'.III <br /> 7• i Unit4 <br /> 8. <br /> 9. ❑ Unk 5 <br /> 10. <br /> Specific Date Range of Information Requested: From ❑ Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> iZ�dINDERGROUND TANK(UST)CLEANUP SITE(LOP) <br /> LOP <br /> THER CLEANUP SITE(NON-LOP) ) ElMEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) HOUSING ABATEMENT El WASTE TIRE U <br /> ABOVEGROUND TANK ❑FOOD FACILITY El DAIRY UM, I, <br /> ❑CHICKEN RANCH/DOG KENNEL EPR <br /> 3 2cl jy <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKREAD/CH PLANT Yy� <br /> AMIdC <br /> ❑TIERED PERMITTED FACILITY OLISPA ❑PUMPERTRUC LICATION SI ES TOILETS <br /> ❑TATTOO/BODY PIERCING ❑LAND (PLEASLISPECIF SITES <br /> COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0 <br /> 0 <br /> PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above. Select the type(')of files from the list above by checking the appropriate <br /> box(es). At least one file fype MUST be selected. Fax to(2091464-0138 or mail to the address indica t rl <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Appilcationsreceiv d caters <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 b schedled accordingly. <br /> 3. A f le that is actjVeI 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$125 deposit prior to review. ***BOXED AREA- <br /> 3-Zp- EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name; <br /> EHD 48-66 <br /> 9/4112 <br />