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Jul_ 2 7 2006 <br />ENVIRONMENT HEALTH <br />PERMIT/SERVICES <br />APPLICANT. <br />FA$ <br />SAN JOAQUN COUNTy <br />ENVIRONMENTAL HEALTH DEPARTM%NT <br />304 Past Weber Avenue, 3'd F1001r, StOC10014 CA 95202-2708 <br />Telephone: (209) 469-3420 Fax, (209) 464-0138 Web; www.sjgov.org/6hd <br />PUBLIC RECORDS RELEASE APPLICATION <br />Z001/001 <br />EHD LOO NUMBER <br />w. VU1..a V l'YT "1."l •.f <br />PHOAIt'(1): Alio .i —{ <br />���� PHONE (2): FAiCSIMILE; <br />TGNTALTIVE' APPOINTMENT DATE; <br />T141 O allow 10 business Rays 1Tom date of apPIICatiOn submrtal-"rmtafive onlymust be confmed) <br />CHECK SON TO EXPEDITE RE2 f - sa3.o FE CASH OR CHECK ONL)j - REQUEST PAOCE3SED IN 3 BU$INEss DAYS <br />SIGNATURE OF APPLICANT ( 'y^lYl� DAA <br />UNTr;I3TRMUI1O11 <br />M Unit 1 ❑ Unit 2 Unit 3 Unit 4 O UnN S ❑n ❑ Uite Otfler—������ <br />(decaroRldOGtslmTps) <br />_ <br />FILE ADDRESS <br />SPreatk_ <br />2.... <br />Stmet Name QNy EHD USE ONLY <br />- <br />3. <br />4. <br />-- <br />ti. <br />6. <br />7. <br />8. <br />—� ..... <br />SpeGtfiC Date Range of IRformailalt R2que7tEd: From OA ._ to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILE; <br />NDEROROUND TAIiI((UST) CLrMur$ME(LOP) ❑ HOUSING ASATIAPENT rt SOLED WASTE FACILITY/V114CLE <br />k/+LU <br />�,(OTHER CLEANUP StTF(NON{OP) r1 FOOD FACLrTY ❑WPIFTIRE <br />NDERGROUNDTAInt(MONrrW re /REraDVAQ ❑ BOO KENNEL ❑ DMr.R' . <br />11 HAZARDOUS WASTE GENERATOR ❑CKOKEN RANCH ❑ WPBTEWATEZTNF{,TIIIQP" PLANT <br />❑ TIEED' PRRaIT>to FACILRY ❑ NIOTEUHOTEL 0 PUrfi ER TgUqCITAMT CNa1 TOILET!: <br />U TATT'OOMODY F IERallo O FOOLlsPA G LAND USE APPUCATKM Srise <br />11 MEDICAL WASTE FACI1JTY O OTHER(PLEASS SPECIFY) <br />WELLAIID SEPTIC PgO&m REra]RM ANE AVAILABLE FOR REVIEW. MONDAYfRiDAY a:00 AEr-6:01)Pra - EXCLUDMA HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type($) of files from the list above by checking the <br />appt'opriate box(es). At least one file type MUST be selected. Fa to 209) 464,44M or mail to the address <br />indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact <br />the EHD. Applications recevad after 8:00 pm will be processed the next business day. <br />2. The END will notFfy the applicant if any END files exist. An appointment for review will be com§noed <br />approximately ten (10) days after receipt of application. The files will be held for a maxlmurn of five btullneas <br />days for review. Appointments should be Scheduled accordingly. <br />3. A file that i., actively being worked on by END staff may not be immediately available for r�!vleiv. A IleTv <br />appfic ation may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the <br />applicant. Future file reviews by the same applicant may require a 593.00 den[I .it nrinr In mvl + <br />fnucd __ <br />