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05/03/2010 14:57 , 4085597P7.1 AEI SAN JOSE PAGE 01/01 <br /> RE <br /> Gr �5 <br /> ED LOG NUMBE% <br /> DANE RECEIVED, EH F <br /> 16,10 SAN JOAQUIN COUNTY I <br /> ir..�. <br /> LF_� ENVIRONMENTAL WEALTH DEPARTMENT <br /> �.ry'vit-�0`�M� �i ,��ALTH' 600 East Dail, St. Stookton, CA 96202-3029 <br /> P E.RtIq'T;'v V1[r' lephone: (209)4683420 Fax. (209)464-0138 Web:www,sjgov.org/ehd <br /> PUBLIC RECORDS .RELEASE APPLICATION ++ <br /> _ r l <br /> APPLICANT: � f �� BUSINESSIAGENCY:� <br /> ADDRESS: .566 CITYISTATEIZIP: ry � L <br /> PHONE(1): l Zq '5PHO E(2): 109 FACSIMILE: u OI <br /> TENT,ATIVE''APPOINTMENT BATE: Time. <br /> (please allow ID buslness days from date of application submittal-•Tentative only-must be eonfirrned) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- FE (G ri PR CHE K ONLY)-.REQUEST PROCESSED IN 3 DUSINE:S5 DAYS <br /> SIGNATURE OF APPLICANTf f�L _ _— DATE �J <br /> Electronic Information: ❑ List❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street fl Street Name City ❑Unit 4 <br /> 3. 2 74 Gn WAI L I N E, fzD J. <br /> A <br /> Unit 3 <br /> 6. <br /> S. <br /> �Inna <br /> 7. <br /> p Unit 5 <br /> 5. <br /> 1 t). <br /> d unit 8 <br /> Specific Data Range a Information Requested: From to <br /> ENVIRONMENTAL HE H DEPARTMENT FILETS <br /> INDERGROUND TANK(115T)CLEANUP SITE(LOP) ❑HUU51NG ABATEMENT [ SOLID WASTE FACkl TYIVEHICLE <br /> R,DTHEP CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> IRRA7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERFO PERMITTED FACILITY ❑MdrELIHoTEL ❑PUMPER TRUCYWARD/0HEMICALTOILETS <br /> ❑TATTOOIBODYPIERCING 0 POOLISPA` ❑LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY <br /> (PLEASE SPECIFY)DI�1�f I wmYe( e P <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MpNpAY-FRIDAY 8:OD Ant-S.ODPM(ExcLUDm r.HOLIDAY3) <br /> 1. List_up <br /> to,ten ddr_eases in the space above. Select the type(s)of filet from the list above by checking the appropr,ate <br /> box(es). At least one file type MUST be selected. 464.0136 r mall W lbegid—dress 1n oVe. Address <br /> ranges will not be accepted-for additional assistance,with file addresses,contact the EHO, Applicationt race after <br /> 3.00 pm will be processed the next business day. <br /> 2. The IEHD will notify the applicant if any GHD files exist An appointment for review will be confirmed approximately tett(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 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 condltfon as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future fits reviews bythe same applicant may require a$115 deposit prior to review. <br /> 5. if you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> f EH6 USE ONLY <br /> t <br /> EHE 48.00 2127148 <br />