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11/04/2011 14:33 8884443080 PEtl PAGE 01/01 <br /> RECEIVEDEHD LOG NUT•�BER <br /> OATF RF(,I Pivp: <br /> SAN a,IOAQUIN COUNTY <br /> v 0 4 2011 ENVIRONMENTAL HEALTH DEPARTMENT b <br /> ENVIRONMENTAL HEALTH 600 East Main 61. S;=Kton, CA 95202-3U29 <br /> PERMIT/SERVICES <br /> AL HES Telephone: (209) 463-3420 Fax: (209)464-0138 Web: www.sjgov,org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATI N . 2: <br /> r l <br /> APPLICANT: � e 1 ps BUSINESSIAGENCY: 41 <br /> ha Ct, <br /> ADDRESS:/moo f/vr a 'r CITY/STATE/ZIP: _ <br /> PHONE(1):�`f/Sr 10-5;7 a g PHONE (2): FACSIMILE_�',9 <br /> TE TATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 buaine»days f tc of opplio Aion cubm I 'Tonfafivo only-must bo confirmod) <br /> [�CHECK BOX TO EXPEDITE REQUES C N O C NLY)•REQUEST PROCESSEO IN 3 BUSIN S D s <br /> SIGNATURE OF APPLICANT DATE l <br /> Electronic Information: ❑List❑ ap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streak �_ Street Napo city Unit 1 <br /> r <br /> —� 2. fr il�nS� D % �P.1 ����� Unit <br /> 1 /ter/n <br /> 4. d Uni <br /> 5. St ,,NC ltb�ii-wy� r j�j <br /> 6. b 11 f , �rJ NC 1._...-.._ .__Un.t4 <br /> 7. <br /> $ ❑Unit S <br /> L110 <br /> � <br /> nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 'n I� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT tLIT WASTE FACILITYIVEHICLE j l f lt. kr <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY SE TIRE f '„I ? y Q <br /> NDERCROUND TANK(MONITORINWREMOVAL) ❑Doc KGNNF.L I;ZY U4 N , <br /> .12�HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT I I—I q-I/ <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL LIMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA LAND UsE APPLICATION SITE <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 Ari-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addin 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 mail to the address indicated above. Address <br /> ranges will not be accepted-for additional aasietance with file addrosnea,contact the EHD. Applioations received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notity the applicant if any FHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days fur ruvierw. Appuintrnerits <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 applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHO USE ONLY <br /> e <br /> c <br /> t f62 x41 0401 I � 31 - <br /> EHO 4"6 07129110 <br />