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0 0 <br /> RE10YED <br /> EHD LO©NUMBER <br /> SAN J�p►QU1N COUNTY <br /> APR 2 1 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St_ Stocidon,CA 95202-3029 <br /> ne:(209)468-3420 Fax: (209) 464.0138 Web: www.sjgov.or;� <br /> PER M'SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY; gbh <br /> ADDRESS: SD:17 IJ. a,x714 'ST CITY/STATE0P: I� A-10 <br /> PHONE(1): 5S9•,2y9• 'YS/ PHONE(2): FACSIMILE: .7Z 1/ice-,t <br /> TENTATIVE'*APPOINTMENT DATE: A t. Soo-► 'S f•t--c tS R--r461 Time: <br /> (Please allow 10 business days from date of application submittal--Tantadve only-must be confirmed) <br /> ❑CHECK BOXTO EXPEDITE REQUEST-$114 FEE(CAS R ECK ONLY)-REQUEST PROCESSED IN 3 13USINESS DAYS <br /> SIGNATURE OF APPLICANT a DATE /70 <br /> Electronic Information: ❑List❑ Map-Descripti <br /> FILE ADDRESS EHD USE ONLY <br /> V4, 1 <br /> et# Street Name city Unit 1 <br /> 401AAkA4,tAc M10A iK T Unit z <br /> 3. <br /> � — nit8 <br /> s. o( n cf <br /> 6. to <br /> 7. <br /> $. Lj Unit 6 <br /> 9. <br /> 10. ®Unit 6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ,f <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE P <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE It <br /> UNDERGROUND TANK(MONITORING1REMovAL)C�, ❑DOG KENNEL ❑DAIRY k � <br /> HAZARDOUS WASTE GENERATDR--- ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTELIHOTEL ®PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODy PIERCING ®POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SGPTIc PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXGLUDINa HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one flie type MUST be selected. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any END flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after mcelpt of application. The flies will behold Por 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 END 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 staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. if you need further assistance,please contact Diaine Martinez,at(209)488-3425. <br /> CHO Uar ONLY <br /> > I ✓ <br /> Z Z yl <br /> END 48-66 8r2TJ09 <br /> T -d ZSbI-6Zz-6SS-t s-.ue-:ljnsuo0 e4jag e.O�IaiS eEib I1 0T Ta icld <br />