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February 17, 2009 11:27 AM From: Tim Loeb Fax Number: (510)278.7112 Page 1 of 1 <br /> fJ �gip`Av(f1��DD (HD l OG NUNIEF4 <br /> J SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT A <br /> FER 1 1 2009 6:1�0 Fast Matra Street, s€pckton,CA 95202-3028 -f/V <br /> NV!Rt�NMFNT HEALgp'hone r ;408-3420 pax: (z )464-0138 wpb;wvwslgxv.o <br /> PFRNrl T(SERVICES PUBLIC RECORDS RELEASE APPLICATION (( <br /> _ . <br /> APPLICANT _____BIISINESS(AGENCY r )C' <br /> ADDRESS. t ' 6 K L�� /G< 1�� ctty!".4atetZip "lltrr, L.D� Fv /P �^•'' —. <br /> PHONE(f Y- C �.�Lc9) S c� t#_7. PHONE(2)i. . "4 8� -1 j.�{ "' �� FAtSAKLEr <br /> TENTATIVE"APPOINTMENT DATE. Time: <br /> (Please allow t0 business days ftem we of apAiitatlan:suhnuhi.1•'Tenlaa've only-must he tnnfirmed) <br /> Q CHECK BOX TO EXPEDITE REQ61EST•$105EE(CASH R CHECKPNLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> "� <br /> SIGNATURE OF APPLICANT '`+,.- / .;t` I GATE ��`.._7�.3 -- <br /> ! _.. <br /> Electronic Information: E]List U Map-Description:_--_-_,__:-._�..... .........__-. _—.....- — <br /> FILE ADDRESSEHD USE.ONLY <br /> €-- Streets _ Street Name Unit <br /> Unit <br /> 3 -_ <br /> unit 3 <br /> 4. <br /> 5 _.. /Unit 4. <br /> 6. <br /> 7. ) ___ n units <br /> _—__----- __._. <br /> 10 <br /> Specific Date Range of Information Roquestnd:From __ _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUNDTANK(U$T)GLFANUPSITT(LOP) 0 HowNOAIATEMenT 0$Oi Io WASTEFACt_IrY1VEHICLE ,1 It r v <br /> M OTHER CLEANUP SITE(NO ,LOP) ❑FOOD FACILITY 0 WASTL Ttp£ <br /> UNDENt3ROUNn TANK(MONri okmoi(Rl:MOVA1 MDia KENNEL 0VAIn" <br /> HAZARMIJS WASTE GENERATOR''' QCHiCKEN RANCH . 0 WASTP-W1pK TPr.AIWNt PLANT <br /> 0 T:ENEn PEIMITTEG FMtLITY.: n.WTCHJHOTL nP,W1rr<TRUC;0WR0iCKtM TeLETS <br /> C TATTODMODY PIERCINGOPo[AJSPA 0 LAND Use APPwATi'INSiTes <br /> EL MEN=WASTS FACILITY CL OTHER(Pt EASE SP£C1rx) <br /> Wi_'Lt, N Sep ficPsRmt r Rt60ODS APE AVAIL/+EufoRREbYEW-fjONiMY^FruGAr800 CM3:OOPs. FXGLLmmay:HOUDAY6. <br /> 1. List up to tan.addresses In the spate ahoy. Select the type(s):of files frorn the list above by check#ngthe appropriate <br /> box(es), At least one file type MUST be selected. Fez to 2q9 4S.id1138 or mail to the address indicated above- Address <br /> ranges will not be accepted..for additional assistance with file"addresses,:con tactthe EHD, Applicationsreceived after <br /> 3:00 pm will be processed the next bustness day. <br /> 2. The EHD will notify the applicant If any EHD Taos exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files vat be field for a maximum of rive 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 <br /> . .Submitted whon the file IS available: . .. <br /> 4. Any file not tutor(act 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 away require a$105 deposit prior to review. <br /> ERD USE ONLY <br /> r-_ <br /> ..._ <br /> EHD 46.06 8Vng F�JR(t(,NKxNtD5 RELEASE APP Fht <br />