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DATE RECEIVED- �nL.Lll=]7�V IYIOLn <br /> SAN JOAQUIN COUNTY <br /> EI' RONMENTAL HEALTH DEP <br /> ARTT - <br /> Y <br /> 1868 East Haze{tonAven 4 2 -6232 <br /> ele hone: 209 468-3420 Fax: 209 4RL <br /> ov.org/ohd <br /> TO <br /> z., 'ObBLIC RECORDS RELEASE APPLICATION <br /> APPL1 t�'j t» BUSINESSIAGENCY: <br /> ADDRESS: , . . CITYISTATEIZIP:4-�4,ae_ <br /> PHONE (1): 13 <br /> PHONE(2): FACSIMILE: t°e ���, <br /> TENTATIVE-APPOINTMENT DATE: Time: <br /> 040 (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK SOX TO EXPEl717E.RECIUE5TI-:7-$1 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT— ___w �. •�.,_., _. _- -.. .._ DATE—�.- <br /> Electronic Information: ❑ List.[I Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City i]Unit 1 <br /> 2_ y©Unit 2 <br /> 3. <br /> Q' R N k []Unit 3 <br /> �. " <br /> / moi/.e— /r39,,, 1c4 <br /> 6. <br /> --G'Gnit 4 <br /> 7. <br /> $. <br /> © Unit s <br /> 9. <br /> 10. <br /> -0-Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> �, ENVIRONMENTAL HEALTH DEPARTMENT FILES �--� <br /> f�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �21OLID WASTE FACILITYNEHICLE <br /> ¢.'!OTHER CLEANUP SITE(NON-LOP) - 0 FOOD FACILITY -ff WASTE TIRE <br /> ©"UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> Q`�I'IAIARDOUS WASTE GENERATOR ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTEUHOTEL EIPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 'PBOMPLAINT RECORDS ❑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 appropriate <br /> _ <br /> box(es). At least one file type MUST be selected. Fax to209 464-0138 or mail to the address indicated above. Address i <br /> ranges will not be accepted-for additional assistance with.file addresses,contact the EHD. Applications received-after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be meld for a maximum 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 immediately 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 reorganized by EHD staff at the expense of the applicant. <br /> Future-file reviews by the same applicant may require a$125 deposit prior to review. <br /> R Ei0 USE ONLY <br /> FHD 48.46 <br /> Sltl17 <br />