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SAN J tHU LL?U(VUMklt y <br /> REEn� LS�lYl ED ENv�RONn� ���U�N COUNTY � <br /> NTAL HEALTH AEPAP TMENT <br /> 304 Fast Weber Avenue, 3`d on, CA 95202-2708 <br /> MAR �� - 7005 Telephone: (209)468-3420 Fenix (209)464-013 Web:www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATT.ON <br /> APPLICANT: &LAJ& <br /> DLfSINESSIAGENGY: �� <br /> ADDRESS: _ <br /> 6112 111 <br /> PHONE(1): PHONE(2)-12CFACSEMIL <br /> TENTATIVE"APPOINTMENT DATE:III <br /> Tme: <br /> (Please allow 10 business days from date of application submittal.0Tej7tatlre only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION O Unit 1 © Unit 2 ❑Unit 3 nit 4 01 Unit 5 0 Unit 6 E3 Mar(electroniollisWntaps) <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 01 <br /> 2. <br /> 0110 Lee 3. — tO W U, <br /> 4. <br /> 5. <br /> B. <br /> 9. 1- <br /> -Y jj <br /> ref <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSII ABATEMENT ❑SOLIR WASTE FACILIrYIVEFSIGI.E <br /> OINER CLEARVIR SITE(NON-LOP) ❑FooD FACILITY d WAsTT:TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ©DOG KENNEL 0 DAIRY <br /> Q HmARDous WASTE GomERATOa a CHICKEN RANCH M WASTEWATER TREATM12NT PLANT <br /> TIERED PERMITTED FACILITY D MOTELIHOTEL PUMPER TRUCKIYARDIGliEM TOILETS <br /> 17 TArTOOIBObY PIERCING 0 POOLISPA D LAND USE APPLICATION SIT <br /> ES <br /> a MEDICAL WASTE FACILITY (PLEASE Sr'EOIKY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVA1WgLE FOR REVIEW. MONDAY-FRIDAY 8:00 Au-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 <br /> appropriate box(es). At least One file type MUST be selected. Fax to 209)464-0138 or mall to the address <br /> indicated above. Address ranges will not be accepted--for additional assistance with file addresses,contact <br /> the EHD,Applications received after 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 roview will be confirmed <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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' <br /> applicant, Future file reviews by the same applicant may require a$93:00 deposit prior to review. <br /> srrnro� <br /> s`. <br />