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_ , <br /> � f <br /> SAKI JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FER 4 2013 1868 Easi.HazeltOn Avenue, Stocklon, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: {249)464-0138 Wets: vpAw.sjgov.orgJ�hd: <br /> ENVIrRC)NMENT,1 s-HEA0'0 <br /> PEFti4j ,ISENVICES PUBLIC-RECORDS RELEASE APPLICATION <br /> � <br /> L ` t BUSINESSIAGENGY: t f L <br /> APPLICANT: /+t ��� o n .'4TA `� t � <br /> ADDRESS: <br /> FLk-A, ,?`�GlTYISTATEIZIP- f� 1 c�l�nstlr�- � Fra f <br /> { T o c-3,� FACSIMILE: <br /> PHONE(1): r�L( 7- �a S - PHONE (2): <br /> TEN7'A'tIVE•`APPOINTMENT DATE: � Time: <br /> r <br /> - d (Please allow 10 business days from date of eiiplicatinn submittal.--TentaLue only-must be conFi€rued) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> f ---- 'HATE s��.../C4 4) � <br /> SIGNA'URE OF APPLICANT <br /> Electronic Information: A List❑ Map--Description: <br /> FILE ADDRESS F-A uSE ONLY <br /> Strttf Street Name KI Unit 1 <br /> (�Onl 2. 1�+ . yI��PTI ` � 'o Ct. ._.. — l�Unite2 <br /> 3. .. <br /> _ 4. E-,`tea I1 _ ❑Ltnit3 <br /> i L <br /> 5. <br /> it't <br /> 7. <br /> 0,00 a <br /> ,.. Ve -e^14. 7V✓V r <br /> '(,�1't 1 <br /> 10. �f t v 1 11 t d L, 4' r^. {l I C^Q' i C3 Unit <br /> I s <br /> Specific gate Range of Information Requested- From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILETS <br /> UNDERGRDUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WA( FACILrtY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-1.017) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ❑ <br /> UNDERGROUND TANK(MONITCRINGIREMDVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HA1AkDOUs WASTEIH=RD4US MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMLCALTRILETS <br /> ❑TIERED PERwrl-ED FACILITY ❑POOLISPA ❑LAND USE APPt_ICATION SITES <br /> ❑`rATT04ISOm PIERCING ❑CDMPLA1NTIRESP4NSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAlLA5LE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00PN1 (E7CCLUDING HOLIDAYS) <br /> 1. List up to ton addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2014)464-0138 or mail to the address indicated_above. Address <br /> ranges will not be accepted -For additional assistance with file address&$,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. Art appointment for review will be confirmed approxiinately ten (10) <br /> days after receipt 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 fife not returned in the same condition as released will be reorganized by EHD staff at the expanse of the applicant. <br /> Future file reviews by the salve 2spp) cant may require a$12,5 deposit prlor to review. '°'t0,9. { a4',.EKP,1$EDy <br /> t <br /> 1 <br /> L'A�� <br /> C� ReeorslsCaldeci`by 5taf -PPR Gump <br /> Esso 4 <br /> Received Time Feb. 4. 2013 12:31PM No. 2218 <br />