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y <br /> tt r <br /> +++ i ,TyJ. sI1 >fi f�* 4�'v°+f - •i 7Z/ 1} 1\Zi?�+ C1JJ�11 iJli11 .ti 'fl <br /> _7 <br /> 304 East Web- <br /> Telephone: <br /> eiTelephone: (209)468-342Q Fax: (209)464-0138 Web:www.sjgov.org/ehd 6 <br /> AM X445 PUBLIC RECORDS RELEASE APPLICATION <br /> tt <br /> + 1�1n <br /> ApPll ". BUSIf�ESSIAGENCY: <br /> ADDRESpp R <br /> PHONE(1): �f���1 PHONE(2): 2 _x_FACSIMILE; <br /> E: <br /> TENTATIVE*APPOINTMENT DATE: I Time: <br /> r (Please allow 10 buslness days from date of application submittal-•Tarlfa&e only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FEE(CASs{OR CHECK ONLY)i-REQUEST PROCESSEDIN 3 BUSINESS DAYS <br /> " SIGNATURE OF APPLICANT DATE ' <br /> UNIT DISTRIBUTION E3Unit 1 13Unit 2 E3Unit 3 ",A `M 4' `.f 3'Unit 6i ❑ Unit 6 Cl Other(electronicllistslnsaps) <br /> PILE ADDRESS II EHD USE ONLY <br /> Street# Street Name City q.. <br /> 2. , <br /> 3. <br /> 4. I� . <br /> 6. I M <br /> 7. E. <br /> 8. <br /> 9• II p <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 , o SOLID WASTE FAcILr YIYEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) a FOOD FACILITY WASTE TIRE <br /> 113 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> C]HAZARDOUS WASTE GENERATOR ❑ CKEN RANCH Ij ❑WASTEWATER TREATMENT PLANT s <br /> 0 TIERED PERMITTED FACILITY 13MM6TELMOTELPUMPER TRUCKIYARDdCHEM TOILETS <br /> t0 TATT0018QDY PIERCING O POOLISPA { LAID USE APPLICATION SM <br /> 3MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY S:OO;iAm-5:00pu - ECCLUDING 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 io 206)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 receives!after 3:00 pm will be processed thy'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 vAl be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly.' 'I <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A new s <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reo ganized by EHD staff at the expense of the <br /> applicant. Future file'reviews by the same applicant may require a$93-.06 deposit prior to review. . <br /> (,..+fes <br /> END 48-02406 - <br /> 11127104 <br />