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_ SAN JOAQUTN COUNTX �V' [HU LV sNVMtlt <br /> F <br /> RECOMED ENVIRONMENTAL,HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`7+to <br /> on, CA 95202-2708 <br /> MAR M� - 7005 Telephone: (209)468-3420 Fax (209)464.013 Web: www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH -PUBI..TC RECORDS RELEASE APkLICATlON <br /> APPLICANT: <br /> BUSINESSlAGFNCY: I <br /> ADDRESS:,�Q�_/ <br /> PHONE(t);OI(ig�� �t� �_i PHONE 2 t FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE; <br /> (Please allow 10 business days from date Time: <br /> or application submittal-"TenraUve only-must be connrtned) j <br /> CHECK BOP TO EXPEDITE REQUEST-$93 .00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS 1t <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 El Unit 2 ❑ Unit 3 nit 4 ❑ Una 5 Cl Unit 6 ❑ <br /> Other(electranionists/msps) i <br /> FILE ADDRESS <br /> Street# Street NameCity EHD USE ONLY2. <br /> } <br /> 1. d - <br /> 3. <br /> /!fit AW Sr Gi to <br /> 4. ts c - G <br /> 0 <br /> 5. <br /> 6. .QlZ1C 1 - ./ <br /> 7. ry.. I i.ti3 I <br /> 10. F ' a <br /> Specific Date Range of Information Requested:From ��/r to 1� Afile-47— <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 17 SOLID WASTE FACILITYlVWICLE <br /> IkK❑OTHER CLEANUP SITE(NON-LOP) ❑Fom FACILITY ❑WASTE TIRE <br /> UNDEROROUNDTANK(MONITORINWFZKMOVAL) 'k O DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑TATTCAL PIERCING <br /> LI MEDICALWASTE FACILITY ❑ POOLISPA //�� 171 LAND USE APPLICATIO <br /> 4�4 N SITE$ <br /> WASAOTHER(PLEASE SPECIFY) A Z AAee <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAYTRIDAY 8:00 AM-5:00PM - FACLUDIN&HOLIDAYS. ' <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the <br /> appropriate box(es). At least One`File type MUST be selected. Fax to(2091464-0138 or mail to the address <br /> indicated above. Address rangeswill not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received af.er3 :00 pm will be processed the next business day.. <br /> 2, The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant, Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> END A9-0tA06 <br /> t1R]NA i <br /> I <br />