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DATE VED tl-IU LVIi NUMtftK <br /> SAN JOAQUIN COUNTY <br /> T 7 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue 3rd <br /> ton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax (209)464-013 Web: www.sigov.org/elid33 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AP � �— ^,E BUSINESS/AGENCY: <br /> ADDRESS:. Ze7 4141419 <br /> PHONE(1): �_PHONE(2):�'����1�5 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be j,, Irmed) <br /> 13 CHECK BOX TO EXPEDITE REQU ST 3.00 F E( OR CHECK ONLY)—REQUEST PROCESSED It 1SfNE7S 2e@6 <br /> SIGNATURE OF APPLICANT CAS DATE 9, e2r, <br /> UNIT DISTRIBUTION ❑ Unit 1 11 Unit 2 13 Unit 3 C3 Unit 4 ❑ Unit 5 11 Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. <br /> 2. 4 6 v y zkla Ze <br /> 3. <br /> �sr <br /> 4. \� <br /> 5. <br /> 6. <br /> 7. <br /> 8. Inow <br /> 9. UVU Lit, _ <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/PEMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD. Applications received after 3:00 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 /> EHD 48-02-006 <br /> 11/23/04 <br />