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D <br /> EHD LOG NUMBER\ <br /> DATE RED ECCEivE Y SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT I O <br /> 600 East Main 5t, "alockton, CA 95202-3029 IUll1 <br /> FE8 Telephone: (209)468.3420 Fax: (209) 464-0138 Web: www Slpov.Drcj/eh <br /> tp, EN NtGES PUBLIC RECORDS RELEASE APPLICATION <br /> ppER r BUSINESSfAGENCY:__OL S�4)r <br /> APPLICANT:— /L .., _l Z?feL5L� <br /> ADDRESS: .__._...._... /-�L. .A �flt Jess -tom=2/CITYISTATEIZIP:_L�cE,,_"r <br /> PHONE(1I: _ ., PHONE IY): _ FACSIIMILE:__ ­ <br /> TENTATIVE'APPOINTMENT DATE. Time, <br /> (Plaaaa allow 10 business days from data j(C <br /> leadom fubmlaai Twi-rive only-must be eoMirmed} <br /> E]CHECK BOX TO EXPEDITE REQUEST-$115 FEE VCKECNREUU�;5T PROCESSED IN 3BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _„� DATE <br /> Electronic Information: ❑ List_] Map—Description: <br /> FILE ADDRESS EHDtE ONLY <br /> gtteets Suasl Name ' City -7 f Vf' I knit <br /> I I`""' <br /> t• ��'t'�rtds�l.2G 7( Ihl .C11gi'cl, Lu.,p Stltr�`fs� 9s�+ 1 <br /> f I <br /> z. .a r r e4a.dwl 3/ JV l�r� Pd ITTr�;4,4it� gs�c! 21 I _ C7 Unit <br /> 3. I s(r ,. 7-2 e3 VT#4,d 4vy <br /> 4 '13 <br /> W' 8'4P'ASA}/k'_ql� . 'di' �� .9gv.? / aunit 3 <br /> S. 1Jur l�r Sv:.>t'!i .'TK7'pl �" !t'1..�.,5.� � IF7s'I� g 7 _ .. .. 7d• <br /> 6. N � Wrsf(�tLk 3JaD/t /I4lt TQC r UI 37�ti unit 4 <br /> T. '�a9lxebirt 8'�`,} Li{e5Fy�51'• ff M4nhcta,� � <br /> e Q Unit 5 <br /> 8. <br /> 10. Una a <br /> 3WHIC Oats Range of Information Requested: From to <br /> ENVIRONMEI_NfALHEALTHDFLE <br /> PARTMENTFIS---- <br /> LJUNDERGRoUNDTANx(UST)CLEANUPSITE(LOP) 1 ]HOUSINGAHATEMENT ❑SOLID WASTE FACILITYfVEWLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) IN FOOD FACIt1TY/"),?Z•LI4k—tt• ©WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIRt'JA OVAL) ❑DOG KENNEL ©DAIRY <br /> ❑HAPAROOUs WASTE GENERATOR CHICKEN RANCH <br /> E2 TIERED PER:TTED FACILITY [I WASTEWATER TREATMENT I A L <br /> ©MOTLIPrIOP0. ©puYIPER TRUCKIYARDfCNC#aCAL TOILETS <br /> r�'�� <br /> TATTOOISODY PIERCING POOLISPA <br /> Q MEDVCALWAStEFACIUTY El LAND USE AFPLICATION STIES© <br /> OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW:MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAY$) <br /> 1. L1sI uu to ten +�r¢a(sa�+s in the specs above, Select ft typs(s)of alas from the list abOVO by checking the appropriate <br /> box(os). At least one,file type MUST be selected. Fox to f2081464-0138 or mail„i ,the address indicat0d above• Address <br /> ranges will not be accepted-for additional assistance witis Nle addresses, contact the EHD. AppRcaNans r0colv0d after <br /> 3:00 prn wNl be processed the next business day. <br /> 2, The EH�O will notify the apphoant if any EHD Tiles exist An appointment fOrreview will be confirmed approximately ton(10) <br /> days after rsceiipt Of application. The Rios will be held for a maximum of rove 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 appLeahon may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be rsOrgantzed by EHD staff at the expense.of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,st(208)468-3426. <br />