Laserfiche WebLink
05/ 23/ 2012 22 : 03 8884' PEM PAGE 01 / 01 <br /> =ETMROMEN <br /> EHD LOG NUMBER <br /> SAN. JOAQUIN COUNTYENVIRONMENTAL HEALTH DEPARTMENT600 East Main St, 8tnWon, CA 95202=39291ephvne: (209) 458-3429 Fax: (209) 464-0438 Web: www. sjgov.arg/ehd <br /> pFRft41T/SERVIGE8 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT•s ` 1 6USINESSiAGENCY: <br /> ADDRESSi �ITYISTATEOP I_ p / rn <br /> f <br /> PHONE (1 ) l5 ��4 — `� R PHONE (2): FACSIMILE TC'' <br /> T TA VL" APPOINTMENT DATE: _ _ Time: <br /> (Please allow 10 business days dategtappuearien su *ratrraare only . fntISt ae confirmed) <br /> CHECK 80X, To IXPEGITE REQU FEI& OR H K LY) • REQUEST mo'CEBSED IN 3 .ausifigss DA <br /> 81GNATURt t7T• APPLICANT — DATE <br /> Electrpnic InfoiTnation; El List ❑ Map — Description: <br /> PILE ADDRESS END USE ONLY <br /> Street # street Name City El Uaiti <br /> 2•_ CJ r nit2 <br /> .. .3 <br /> 4. <br /> r. U5 63 ar cl pf <br /> jj! 171U11114 <br /> Lm <br /> ❑ Unit5 <br /> Q nit6 <br /> Spoclfit Date Range of lnremiAtipn Requested: Froth 10 49 <br /> ENy1RONMENTA6 HEALTH DEPARTMENTfILES <br /> UNDERGBQUNOTANKW5T) CLEWUPSRE (LOP) ❑ H0U5Q*A8ATEl&NT X. WLID WASTE FACUTYNENICLE <br /> OTHERCI.EANUPSITE (N0N•LQP) © FOODFACILITY ❑WA3TETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) © 000 KENNEL El DAIRY <br /> AMIX)LIS WASTE GENERATOR ] CHICKEN RANCH U WASTEINATERTPWATMENT PLANT <br /> TIERED PERMITTED FACILITY © MortiHOTEL �r�`NIMPER TRUCKIYARDICHEMICAL TDILEfS <br /> TAT(0016QOY PIERCING ❑ PQaLtSpA ►vT LANG U4G AppLICA'f10N SnEC <br /> ME0ICALWA5TE PACILDY © OTHER (PLEASESPECIFY) j <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REViEw: MONDAY-FRIDAY 8&00 AmS&00PM (ExCLUINNG HOLIDAYS) <br /> 1. 1 1st un to ma addresses in the space above. Select rile types) aF Tilas from the list above by checking the appropriate <br /> box(es} At least Ona file type MUST be soioetad. F,�x_to (2091484.0188 or mail to the addhass indlcated strove. Address <br /> ranges will not be accepted - for additional assistance with file addresses, Contact the EHD. Appliratlons 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. Tho files will be held for a maximum of five business days far mview- Appnintmont> <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 he <br /> submitted when the filo is available. <br /> I 4. Any file not returned in the same condition as released will be reorgantted by EHD staff at the expense of the applicant <br /> j Future file reviews by the same applicant may require a 5422 deposit prior to review. <br /> i uscen�ty <br /> h <br /> eaeaane oIf29I10 <br />