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MAR-16-2607 68:26 _ TE RACON — ROSEVILLE 916 784 3487 P.Olzoi <br /> s �� EHE}LOG NUMBER <br /> (C3 DATE RECE E �1SAN JOAQUIN COUNTY . <br /> l�lC �� I'= 11 �0 E+NVIRONMENTALDEALT DEPARTMENT ' <br /> 1 <br /> 304 East Weber Avertue,P Floor, St kion,CA 95202-2708 <br /> MAt= -1 6 ?007 Telephone:(249)468-3420 Fax:(204)464-0138 Web: www.sjgov.org/eh <br /> IVVIRUi ;4 c1u F{EAL11i PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS- i <br /> PHONE(i): •� pHONE(Z):_ , FACSIMILE: �IA•7��•_ �� <br /> T£NTATIV£*APPOINTMENT DATE: J /011f- Time: <br /> (Please allow 10 business days front date of application sub ilial-•Tentative only-must be car fimted) <br /> D CHECK BOX TO EXPEDITE RgQUEST-$96.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN S BUSINESS DAYS � <br /> SIGNATURE OF APPLICANT jY2hgtLrL DATE S/1 tP ID,�' <br /> VV <br /> I <br /> F_lectronic Information: ❑List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> $treat 9 Street Nanta �- City Unit 9 <br /> 2 � — O Unit 2 <br /> 3. Unit 3 <br /> 4. . <br /> un 4 <br /> 7. units <br /> 9. Unit 6 <br /> 10, I <br /> Specific Date Range of information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0UNDERGRouND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING AnATEMENT _,M-SOLID WASTE FACIL"Nemol.& <br /> ClCl Food FAciLnv 0 WASTE TIRE <br /> OTHER CLEANUP SrrE(NoH-t-OPy ' <br /> EL <br /> MOVAL) M Do*KENNEL Q DAIRY <br /> / Q C14ICKEN RANCH O WASTEWATER TREATMENT PLANTrsEo PERNpTTEP FAOgJTY 0 MOTEUHQTEL t3 PUMPER TtwcK1YARD1Ci4sm TaLETs <br /> 13 TATTOOIF3QUY PIERGNG <br /> C3 POOL1SPA Q LANo USE APPLICATION SRES <br /> D MEDICAL WY M FACILITY CI QTNt:R(PLEASE SPEC FY} <br /> WELL AND SEPTIC PERmrr RECORDS ARE AVAILAW-E FOR REVIEW- MOM AY-FRIDAY 8:00 Axl-S:00PM - &.6LUOrING HOLIDAYS. <br /> 1, List stip to ten adilmsses in the Space above. Select the type(s)of fi es from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fa to 209 64 138 o mail to address n icated a cve- .Address <br /> ranges will not be accepted—for additional assistance With file add reseet,contact the EHD.Applications received ager <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHO will notify the applicant if any EHD files exist. An appointr nent for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximi.m of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be imm ediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reor.janized by END staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$95.00 dep nit prior to review. <br /> EHD USE ONLY <br /> TOTAL P.61 <br />