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JUN-14-2010 MON 04:56 PM FAX NO. P. 01 <br /> L— V EHD LOG NUMBER. <br /> -- <br /> k °SAN J�?A{�UtN f'+OUNTY <br /> JUN 1 4 u',11 ENVIRONMEN'rAL. HEALTH DEPARTMENT <br /> 600 East Mail) St.':;l.ockton, CA 95202-3029 <br /> one:(209)468-3420 Fax: (:209)464-0138 Web: www.sjgov-org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Karen E)USINF_SS/AGENGY:IDe,rl JcerQ.ddle r Ik LL r <br /> ADDRESS: 50 t-ftMan S+ 20"'icl,. CITY/STATE/ZIP; an.Pro ncI C I o S <br /> PHONE(1):(w/s) 59 1 "7572 .PHONE (2):�trr ) 5 Iw ,`5,D FACSIMILE:�`�/ 591-7510 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data ofof application submittal-"Tentatlya.only-must be confirmed) <br /> 01-HECK BOX TO EXPEDITE REQUE T-$115 F F(CASII OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—DescriptIOW <br /> _FILE ADDRESS _ EHP USE ONLY <br /> StreettR Street Name city El Unit 1 <br /> I. -..00- U - C1.,_rncl. <br /> 2 ---- -- <br /> 3. <br /> ,4. nit 3 <br /> 0M N <br /> �• � �`��• x�`�. _._. _. •. nit 4 <br /> ❑Unit 6 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Infermatiori Requested: From ,Q f,@.ersefto ' fl,____ reSt04 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES —' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP). C!HOUSINGASATEMENT ❑SOLIDWASTE FACILITYME;HICLE <br /> JOTHER CLEANUP SITE(NON-LOP) C.i FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) C I DOG Ki NNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR C I CHICKEN RANCH ❑WASTEWATERTREATMEN1 PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTEIJHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBOpY PIERCING C I POOLISPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY I OTHER(PLEASE.SPECIFY) A 13 0 41 I Lir,11 pe rm l f$ .nd d r;l lin ?eon r I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE:FOR I�i5VIEW: MONDAY-FRIDAY S:OQ AM-5:OOPM(EXCLUDING HOLlPAY� <br /> 1..List up to ten addresses in the space above. Soloct the types)of files from the listabove by checking the appropriate <br /> box(es). At least one file type MUST be selected. FaxIq t2091464-01138 or mail to the ad rasa 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 END 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 for.review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD stat, bet! t !able for review. Anew application may he <br /> submitted when the file Is available. <br /> 4. Any file not returned In the same condition as relirased will be reorganized by FHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$116 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)48.8-3426. <br /> f:i1D USE ONLY <br /> _ &!27!08 <br /> EMP 4"6 <br />