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OCT-19-200.5 WED 0229 PN FAX N0. op P. 01/01 <br /> GATE RECEtVFJ SAN JOAQUIN COUNTY <br /> ;c AL1'H1)GPARTI�IFNT <br /> I+;NVi120NMi NCALII�F, CA 95202-2708 <br /> 209 464-0138 Web:www•SJgnv.or�ohd <br /> - 3040 F,c(209)468A420 Fax: (I 1 r,Stoc cton, <br /> 2� 1 <br /> ���0;di ,t _111.,1C RECORDS R'ELFASE APPLICATION t w� <br /> ER {� d��� BUSINFSSIAGENCY: !. Z <br /> APPLICAN 1GU —' 76 d2 <br /> ADDRESS:2 PHONE(Z): <br /> PHONE(1) mUtb*confirmed) <br /> : Time:1� . <br /> TEN ATIVE' APPOINTMENT DATE: <br /> (Please allow f0 bosiocss days from date of apPli OR C submittal.)_REQUFST Only <br /> IN 3 BUSINESS DAYS <br /> CHECK ONLY)- <br /> (? CHECK BOx TO EXPEDITE REQUEST-s93.0O FEE(CASH OR DATE <br /> SIGNATURE OF APPLICANTunit 5 Unit e q Ott e,(elec�onidl ts maps) <br /> ."W�. <br /> Unit 3 it 4 <br /> ❑ Unitf LT unit <br /> UNIT Pis MISUTION � _. �� -- AHD USE ONLY <br /> -,- — <br /> FILE ADDRESS -- --- - City- <br /> "Stractk - Street ame <br /> _3 <br /> 4_ _. _.-- - - - - - _ - - - - - ---- -- - - - - <br /> 7. to <br /> -. - -- - -'-'- - - ^ -- - - -- - -- - - -^ -. ---- - -- - --- - <br /> 10. - <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES OSOLID WASTE FACILITYIVEHICLE <br /> 11 HOUSING ABATEMENT [j WASTE TIRE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) t3 FOOD FACILITY ❑DAIRY <br /> .OTHER CLEANUP SITE(NON-LOP) Q DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> V UNDERGROUND TANK(MONITORINGIREMOVAL) [I CHICKEN RANCH ❑PUMPER TRUCKryARD/CHPM TOILETS <br /> b1 HAZARDOUS WASTE GENERATOR D MOTELtHOTEL O LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑pOO1JSPA <br /> CJ TgTTDO1600Y PIERCING In OTHER(PLEASE SPECIFY) <br /> L]MEDICAL WASTE FACILITY MONDAY-FRIDAY S:oO AM_ 'SP,,,M.,� BxCLUDI. .., ^'�"-`-- <br /> __ Wells)' f files from the list above by checking the <br /> WELL AND S�PERMIT RRD�R^•�ILABLE P w.�.-,0MOAY "•'- <br /> 1.-Llst up to ten addresses in the space above. Select the <br /> es will not be accepted-for additional assistance with file addresses,contact <br /> appropriate box(es)- At least one file type MUST be selected. Fax to 209 464-0136 it mail to thea res — <br /> indicatel d�bpVe' Address rang P P <br /> y. <br /> the EHD. APP ointment for review will be confirmed <br /> Applications Add received after 3:00 m Will be processed <br /> the next business a <br /> 2. The EHD will notify the applicant if any EHD files exist. An app <br /> approximately ten(10)days after receipt of application. 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 is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. EHD staff at the ez ense of the <br /> applicant may require sire a$93.00— poSlt prior t�review� <br /> 4. Any file not returned in the same condition as released will be reorganized by <br /> applicant. F :tura file reviews by the same app -- - - - <br /> EMI)Aa 02-006 <br /> waros - <br />