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04/18/2013 21 :44 FAX 2001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTIII DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, St, ckton, CA 95202-270 <br /> 2C Telephone. W <br /> (209)468-3420 Fax- (209)464-0138 Web: www.sjgov.org/Zd 1 :5 <br /> PUBLIC RECORDS RELEA�E APPLICATION <br /> APPLICANT: I BUSINESSIAGENCY: 4.0 4 n S.9 ry I a <br /> ADORP-88: 73 A;_3S )CO a I IL, �'.L&4.,_ C/4 <br /> PHONE(t): '01114_4e%n 07.10:1 PHONE(2): -111.6 :3 TSPS3 <br /> ) <br /> TENTATIVE*APPOINTMENT DATE- /0:2 Time: <br /> (Please allow 10 business dayeftm da of application sub 0nittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-;95.40 FEE{CASH OR CHEC 'ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DAW S 1 0:7 <br /> [Electronic Information: 0 List[]Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Str0at0 Street Nam Y CQ unit I <br /> D Unit 2 <br /> Unit <br /> 4. 401P 3 <br /> A <br /> A v e-, <br /> IV <br /> IS- czfi <br /> Un <br /> 8. <br /> 9. Unit 0 <br /> Specific Date Range of Information Requested.From to <br /> ENVIRONMENTAL HEALTH 1312i'ARTMENT FILES <br /> id UNDF RWOUND TANK(UST)CLEANUP SIM(LOP) 0 Housiko ABATEMENT 14 SOLU)WASTE FACrLrTYIVglqtcLE <br /> F9 0-mcp CLaAmup SITE(NON-LOP) El FOOD FAcwty 0 WASTE TIM <br /> I!(UNDERGROUND TANK(rAONITORINO/ftMOVAL) 0 Dor,KENNEL 0 DAIRY <br /> 10 HAzAROous WASTE GENERATOR In CHICKON PILANCH rl WASTEWATER TREATMENT PLANT <br /> 14 TIERED PERMITTED FACILITY 0 MOTE1016TCL E3 PUMPER TRtjCKjYARDfCHEM TOILETS <br /> M TATTMOODY PiFWNQ 0 POOLISPA C1 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY E3 OTHER(PLEASE SPEC FY)_ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONPAY-FRIDAY 0.00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ton addresses In the space above. Select the type(s)of A es from the Ilaabove by checking the Appropriate <br /> box(eB). At least one file type MUST be selected. FAX to(2=091 46 133 or mail to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with file ad resees,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 appoln ent far review will be conflrffmd approximately ton(10) <br /> days after receipt of application. The files will be held for a maxi LIM Of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked an by END staff may not be imI diately available for review. A now application may be <br /> submitted when the file is avallable. <br /> 4. Any file not mtu mad in the same condition as released will be rear nixed by EHD staff at the expense of the applicant. <br /> Future file revleim by the Sarno applicant may require a$95.00 de;patt prior to review. <br /> EHD USE ONIL� <br /> ENO a-"wiaQ00 <br />