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04/05/2010 14:33 FAX 9163722565 WALLACL=-IUHL AND ASSOC. 2001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> D S ENVIRONMENTAL HEALTH �^E�'4EED) <br /> 600 East Main St. Stocktol� i <br /> �'+9Ei20 9 <br /> /^�_ � Telephone: (209)468-3420 Fax: (209)464-p1 8 eb:www.sjgov.org/ehh /' F <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Eft ;` . f� <br /> BUSINESS/AGENCY: W­k\.ce_ Okj cwt. Ash <br /> ADDRESS; g—A otQ BLVD CITY/STATE/ZIP: V65T' 5AC_9ArM4E_nlM CA <br /> PHONE(1): ,IV 3~? 1LJ'3 y PHONE(2): FACSIMILE: 916 372 Zs�S- <br /> 7LcNTATIVE`APPOINTMENT DATE: L�• ? - /C) Time: 2.'6d d_'-' <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> [I CHECK BOX TO EXPEDITE RST-S115 FEE(CASH CHECK ONLY)-REQUEST PROCESSED W 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_�7 DATE L{• $- L o <br /> Electronic Information: ❑ List❑ Map— escription: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name city ❑Unit 1 <br /> 2. ?.lf d cn I-G Gf Unit <br /> 3. AAA f it <br /> 4. <br /> s. 4 <br /> 7. <br /> s. ❑Unit 6 <br /> 9. j: <br /> Units <br /> Specific Date Range o nformatlon Requested: From 7 to Boer .^ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 9DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> HFR CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> [2VTJ TANK(MONITORING/REMOVAL) DOG KENNEL F1 DAIRY <br /> [�'1AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIMOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TATTOoIBODY PIERCING ❑POOLISPA ❑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 ton addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <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 flies exist, An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held 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 retumed 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$116 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> EHD U9E ONI.T <br /> EHD 48-06 <br /> BI2T/09 <br />