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06/11/2007 09:43 FAX _ Z002 <br /> EHD 1,0G NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY ; <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> LD) -3029 <br /> 600 E. Main Street;Staekton,CA 95202 <br /> 2607Tele: alone: (209)468-3420 Fag: (209)464-0138 Web:ivww.sjg0v.Org/ehd <br /> JUN .1 <br /> T 'UBLIC RECORDS RELEASE APPLICATION <br /> "ICiVDJ �� �r Oc/ a r1` BUSINESSIAGENCY: �.7A DZ � <br /> AP . <br /> ADDRESS: <br /> �� —ft3-/ --A 0��PHONE(2):1���Ia � 3 ' FACSIMILE; <br /> PHONE(1): <br /> ifs �'7� f� 'I <br /> TENTATIVE*A POINTMENT DATE: <br /> (Please allow 10"business days from date of application submittal-*rentative only-must be confirmed) <br /> ❑ CHECK BOX TO ExPE )ITS REQUEST-$95. 0 FEE( SH OR CHECi(-ONLY)•i�F,�tUEST PROCESSED IN 3 BUSINESS DAYS ! <br /> SIGNATURE OF APPLIGA JT <br /> DATE <br /> Electronic Information: ListIRNap-Description: LO�IU�_ R�� <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> r2. <br /> CCiIP?QN7 l- -rteunit 2 <br /> ❑ Unit <br /> 4• <br /> K85. <br /> ]F�r <br /> 7 El "unit"5 <br /> . <br /> g, ❑ Unit-6 ' <br /> 10. <br /> Specific Date;Range of Infor nation Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CL ANUP SITE(LOP) 0 HOUSING ABATEMENT 11 SOLID WASTE FACILITY/VEHICLE <br /> M OTHER CLEANUP SITE(NON-LO ')- - - Cl FOOD FACILITY I WASTE TIRE <br /> Cl UNDERGROUND TANK(MONITOR VG/REMOVAL) ❑DOG KENNEL- E3 DAIRY . <br /> 17 HAZARoouS WASTE GENERATO ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> •TIERED PERMRTED FACILITY M MOTELIHOTFL ❑PUMPER TRUCKIYARDICHEM TOILETS - <br /> CI TATTOOIBODY PIERCING 0 POCIUSPA 13 LAND USE APPL16ATIONISITU - <br /> ❑ MEDICAL WASP@ FACILITY 13 OTHER(PLEASE SPECIFY)_ <br /> WELL AND SEPTIC PI RM7 RECORDS ARE AVAILABLE FOR REVIEW- MONOAY-FRIbAY 8.00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses n the space above. Select the type(s)of Tiles from the list above by checking the approprlate <br /> box(es). At leastone file type MAST be selected. Fax to 209 464-0138 or mail to the addresslndicated above. Address <br /> ranges will not be accep ad—for additional assistance with file addresses„contact the EHD.Applications received after <br /> 3:00 pm wHl be processc 1 the next business day. <br /> 2. The EHD will notify the a Iplicant if any EHD files exist. An appointmentfor review will be confirmed approximately ten(10) <br /> days after receipt of app cation. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled ac. 3rdingly. <br /> 3. A file that is actively bell g worked on by EHD staff may not be immedlatelyavailable for review: A new applicatlon.may be <br /> submitted when the file I i available. <br /> 4. Any file not returned in tie same condition as released will be reorganized) by EHD staff at the"expense of the applicant. <br /> Future file reviews by th. same applicant may require a$95.00 deposit prilnr to review. <br /> fHD USE ONLY <br /> EHD48-08 9113!2906 web - - - <br />