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� 5' 05(FRI) 17:02 VERS-'n INC. TELAI-91)622678 P. 002 <br /> r <br /> 02,23/2005 1 h 66 4640138'6� ENVIRONMENTAL HEHI,%„/ P46E 01 <br /> Cnu 401.NUMOC,n <br /> (' I )�D SAN JOAQUIN COUNTY <br /> X11 ENVIRONMENTAL HEALTH DEPARTMENT <br /> F� ; X005304 East Weber Avenue, 3r1 Flgor, Stocktoii, CA 95202-2708 2 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ebd <br /> ENVIROW,IENT HEALTH 3 <br /> PEI?YIT;SERVIas PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; I��V� 6p; I I puSINESSIAGENCY: Ly.4z.0 <br /> AMR85: -7 st t-I Lt ie �1 i-4e�,,�{y(r 6'T <br /> PHONE 11): °I�L�— 9L3 ` '1Z4;HONLm! FACSIMILE: g16 —j�I2 <br /> TENTATIVE'APPOINTMENT PATE, Time: <br /> (Pleaxe allow 10 business days from Bats or application aubminsl-"realative only-must be connrmsu) <br /> Q CHECK BOX TO FXPEOITE REQUEST-$93.09 Pelt(CASH OR CHECK ONLY)—REQUEST PROCESSFP IN 3 SIUSI ee5 AYS� <br /> SIGNATURE OF APPLICANT DATE- Ille of: <br /> UNIT CISTRIaUTION 70ounit 1 IUnit rit i JIFUnIt 4 Anit 5 gFunit S ❑ Other(al sc ron c Is maps <br /> FILE ADDRESS -„--_ bHD USE ONLY <br /> t— �L <br /> StreetNamo City <br /> o :44 N R• ZL 0v .,- <br /> 3 <br /> �( . el <br /> twlt►S . 4. I Mal <br /> Ar ..... E7 r <br /> Specific Data Range of Information Requested; From ) I to <br /> ENVIRONMENTAL HEALTH DEPARTMENT MILES, <br /> Ar P SOLID WA6TE FACILIrYrVEKICLE <br /> r❑auNDURGRouNci TANK(UST)CLEANUP ane(LOPI ; HQU6ING APATEMENT V WASTIi TIRE '! <br /> l�OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> UNDCROROUND TANK(MONIToRINOIREMOVALI M DOQ KENNe. L7 OMNY <br /> Ifni HAZARDOUS WASTC GENYRATOR 0 CNIOKEN RANCK �WAareWATeR TREATMENT PLAKT <br /> V TIEn%P PFAMITTED FACILITY OMOTEUHOM -WPUMPERTRuCKIYARDlCHEM TOILETS <br /> ❑TATTOOL WAS e F C ILI O'nJERUPOOLISPA ❑LAND USE APPLICATION SRCC — <br /> 1�MEOIDAL WASTE FACILITY POTHER(PLEASE SPpOIPY) <br /> WELL AND SEPTIC PERMIT RCOORD6 ARE AVAILAOL9 FOR REVIEW - MONDAY-FRIDAY 1:00 AM-5-00FM E%CLUDING HOLIDAYS. <br /> 1, List up to tan addresses in the apace above. Select the type(s)of 11106 from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected, j x to 12091464-0138 or irIail to the address <br /> inClcaLed�bove. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD. Applications received after 1:00 pm will be processed the next business day. <br /> 2. The EHD Will notify the applicant if any EHD files exist. An appointment for revlow wlh be confirmed <br /> approximately ten(10) days after receipt or 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 FH13 staff may not he immediately available for review, Anew <br /> application may be submitted when the file Is availapia. <br /> 4. Any file not returned in the same condition as released Will be reorganized by PHD staff at the expense of the <br /> applicant, Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD Ae�xaox <br /> ,+N7;04 <br />