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DA <br /> M�TEDO � SAN JOAQUIN COUXNTY � EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 0 3 ZQd$ 600 East Main Street, Stooklon, CA 95202-3029 <br /> Telephone; (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or /e <br /> ENVIRONMENT HEAD: l <br /> pggh tTLSERVICES PUBLIC RECORDS RELEASE APPLICA N <br /> APPLICANT: SIA SUSINESSIAGENCY; <br /> ADDRESS: —9-Q2 Indus-WaL__ay CItylStatn0p odi, CA-95Z40 <br /> PHONE(1): - PHONE{2): FACSIMILE: 2Q2--1 228 <br /> TENTATIVE*APPOINTMENT DATES' '� Time: <br /> (Please allow 10 business days from date of application submittal-"Ten;atfvp only-must be confirmed) <br /> C HIECK BOX TO EXPEDITE:REQUEST $106 FE ASH OR CHECK ONLY)-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7-5-QF- <br /> Electronic <br /> —5-QF- <br /> Electronic Information: 0 List El Map—Descriptiok—, <br /> FILE ADDRESS EH13 USE ONLY <br /> _ Straat 0 Street Name Clty ❑ unit 1 <br /> Iri <br /> 2• � 0 _ ❑ unit x <br /> 3. �o�-C amiciar SDFf <br /> 4. 1 <br /> �}a ^�a _Gert G iU� �', Unita <br /> 6. Untt 4 <br /> . © Unit 6 <br /> 9. <br /> 10. ❑ Un[tS <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> t(I <br /> NDERGROUND TANK{UST)CLEANUP SITE(LOP) �HouslNO ABATEraENT 0 SOLID WASTE FACIUTYIVENICLE <br /> THCRCLEANUfiSITE(NON-LOP) FOOD FACILITY 0 WASTETIRENDERGROUNDTNK(ftlIONIrOMW01REMOVAL) CI DOG KENNrL C I DAIRY <br /> A7Ai WUSW4TEOENERATOR I3 CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> IeR>p PERMITTED FACiuTY 0 MOTEU140TEL 0 PvMPERTRUCKIYARDICHEM TaILETS <br /> ID TATTOOIBGDY PIERCING 0 POOLISPA C7 LAND USE APPLICATION SirEs <br /> 0 MEDICAL WASTE FACILITY ©OTHER(PLEASE SPECIFY) <br /> Well,AND SEPTIC PERMIT RECORds ARE AVAILABLE FOR AGMEW-MONDAY-FRIDAY 8:00 Am-6:00PUI -EXCLUDINa HOLIDAYS. <br /> 1. list up to ten addresses In the space above. Select the type(&)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12091464-81x8 or mall to the address Indicated above. Address <br /> ranges will not be accepted M for additional assistance with file addresses,contact the END. Appilcations received after <br /> 3:80 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 tM confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 ENA staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any fife 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$106 deposit prior to review, <br /> EHD USE ONLY <br /> EHD 48.06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />