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i <br /> 05/03/2020 14:57 408559?�-01 REI SAN JOSE WAGE 01/a1 <br /> DATE RECEIVED,_ .,; E#iD LOG NUMBS <br /> 0 3 Lola SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRCINN`E-I i 14FU LIK <br /> v 600 East Main St. Stookton, CA 95202-3029 <br /> M, t'_R` C, le phone: (209)4683420 Fax: (209)464-0138 Web:www.sjgov:ar4g/ehd <br /> i <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY, U <br /> ADORES$: 5�1 07 108CITYISTAT'E/ZIP: J()'�e. Z <br /> PHONE(1): qPHONI_.('): _46�1 FACSIMILE: Q <br /> TENTATIVE*APPOINTMENT BATE: Time: <br /> (Please allay.10 business days from date of application submittal-"TenWfvg only-must be confirmed) <br /> ❑CHECK 80X TO EXPEDITE REQUEST- 1. FE (rMH PR CHE K ONLY)-REQUEST PROCESSED IN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 5lreet R Street Name City ❑_ Unit 1 <br /> � Z5 TKAO _FF_VD_ . <br /> 2. <br /> Unit 2 <br /> 3. 2� Vv D � co'?5z) I <br /> 4, <br /> Unit 3 <br /> 5. <br /> 6. <br /> U111:4 <br /> 7. <br /> 8 <br /> 0 Unit 5 <br /> 9. <br /> I <br /> 10. <br /> 0 Unit 8• I <br /> Specific Data Range of Information Requested: From to I <br /> ENVIRpNMENTACHE H AR bNTFILE$ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑!HOUSING ABATEMENT ❑SOLID WASTE FACILriY/VEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONiTORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ��AZARDOUS WASTE GENERATDR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ,��[�11EREO PERMITTED FACILITY ❑MOTEL oTEL ❑PUMPER TRUCKIYAR0/CNtMICAL TOILETS <br /> ❑ ATTOOftDY PIERCING 0 P0011SPA h El LAW USE APPLICATION SITES <br /> El MEDICAL WASTE FACRAY ,OTHER(PLEASE SPECIFY) &I`•!q VPZWo f'�e��', •0 <br /> MLS AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Ani-5.00PM EXCLUDING HOLIDAY$) <br /> 1. List un to ten addresses in the space above. Select the type(a)of flies from the list:above by checking the appropriate <br /> box(es). At least One file type MUST be selected. Fax to(209]4640136 or mall to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EI-10. Applications racefved 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 appofntmentfor review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be hold 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 stall'at th4?expense of the applicant, <br /> Future file reviews bythe some applicant may require a$115 deposit prior to review. <br /> 5. If you neer)further assistance, please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> END 4"0 IV27164 <br />