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■7ti Feb. 1. 2016 2:57PM No. 1473 P. 1. <br /> r DATE RECEIVED EHD LOG NUMBER <br /> r■ SAN JOAQUIN COUNTY <br /> 1[7 RECEIVE® ENVIRONMENTAL, HEALTH DEPARTMENT <br /> 4868-East-Hazelton-Ave,nu"toGkton E'"6206-62 <br /> FEB 0 1 20% Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> BmROfvIfa ENTALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a Ad,� Ick SINESSfACENCYM,ynudIow'DInmpal <br /> ADDRESS: T10 Tru±tAn AvfnUCITY/STATE/Z(P: s <br /> PHONE(1): ((0101)'395 -I(pAL0 PHONE(2): FACSIMILE:0) 3gS-IUlk <br /> TENTAME'APPOINTMENT DATE: ? 112 1(, Time: 11: Q0 <br /> (Please allow 10 business days from data of Application submittal-`Tenfauve only.must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE <br /> " l,) <br /> (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT t/ la(&{(ltLf .(`IC DATE (0 <br /> Electronic Information: ❑ List❑ Map—Description: 1 <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> ,. 2 'oun+r V NVA AUck <br /> 10,03 couOr 1 0141, 1 5 t eL h toy y� /0 Unit 2 <br /> 1. <br /> d 3 L13 ' (0 1211 U CK� L` Uo G{�-tnA Co.:? No aA41W W/5 Ung 3A <br /> 4. Unit a <br /> G 5. <br /> 6. <br /> tlnitb <br /> 7. <br /> 8. <br /> ❑UnItS <br /> 9. 1 i Fr}b-- 1�irt <br /> Specific Date Range of Information Requested: From MQt to F me r '{ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES - <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE, .1 <br /> ®OTHER CLEANUP SITE(NON-LOP) ElHOUSINGABATEMENT El WASTE TIRE f. 6 ho (�{a,%un t <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)De- ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK 0CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT' <br /> l ❑ <br /> M HAZARDOUS WASTEIHAZARDOUS MATERIALS IX ElMOTELIHOTEL - ❑PUMP ER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ®COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FR(DAY 8:00 AM-5t00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to.(209)464-0138 or mall to the address Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <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 recelpt of application. The files will be held for a maximum of five 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 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 a Qlicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. � qX=W En?? � <br /> 3 r 31 bis <br /> o . <br /> Q Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time—Feb. 1. -2016— 2:59PM—No. 0430 a,Aite <br />