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No. 2840 EIP. 10 NUMBER <br /> DAT I: <br /> fi0 `� SAN JOAQUIN COUNTY <br /> E (RONIMENTAL HEALM DEPAR <br /> Nv TM- T <br /> Ur <br /> 'j 1868 East Hazelton Avenue,StocKon, CA 95205-6232 <br /> -11 1, 0 <br /> Z U I i ".w'r," <br /> Telephone: (209)468-3420 Fay,: (209)464-0138 Web;www.sjgov.org/ehd <br /> A <br /> P-TV-11 R 0 i1,J�'E N ri-1-1 r-1,i I=A FT H PUBLIC RECORDS REL2ASE APPLICATION. <br /> C <br /> Lm <br /> BUSINESS/AGENCY: Sj COV-0t, pub i I� WOK-1-11-q <br /> ADDRESS: j. I o r-- J—H <br /> ?) �/'j�� M/Y,, Clcf1STATF=/ZIP: <br /> PHONE(1): IM- PHOK�E(2): FAX OR E-MAIL: '(2vq) Lih4z— 24q6 <br /> Please aflow 10 busipess days from date oftapplication Subtmittal for tho records to be avaUaLlo. <br /> Staff will contact you to arrange an appointment date.and time to review the requested records. <br /> F]' <br /> C'HEBOX TO EXPEDITE REEC 0[,Lo-REQUEST PROCESSED IN 3 BUSINESS DAYS'C-K— ------- <br /> SIGNATURE OF APPLICANT D AXE J- <br /> 1. List u_p to ten addresses in the space h-e[ow. Select the type(s) of flies from the Elst below by ohockIng the appropriate <br /> box(es). At least one file type RiUST be selected. Fax to(20 4-0138 or mail to the address inicated above. Address <br /> ranges will not be accepted.Appilcatioris received after 3:00 pm veill be processed the next business day. <br /> 2. For assistance in identifying the nature and content of ERD records, please contact EHD at the number noted above. <br /> 3. The EHD will notif-vYtha anplicar:,t if Ary EHD fileS eKiSt. An S-Ppo!ntment for review will -ba- co-i-firmad <br /> days after receipt of app[icatlon. The f1les W111 be held for a maximum of five,business days for review. Appointments <br /> should be scheduled accordingly, <br /> 4. Any file not raturned 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$130 deposit prior to reviekrv. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONIDAY-FRIDAY 8:00 AX-5:00PM(EXCLUDING HOLIDAYS) <br /> i Electronic Information: 0 List [] flap-Descriptlon.- <br /> Tpecific Date Range of Information Raquesfed: From to <br /> ENVIRONMENTAL --1 <br /> t-fEALTH DEPART MERT <br /> MES FILE ADDRESS EHD USE ONLY <br /> --ffIJ1DERGR0IJND TAM((UST) street# Street Name City <br /> CLEANUP SITE(LOP) r <br /> OTHER LF-ANU SrTE(NoK�-LOP) LQ,)I� , � -71 eR I <br /> H Dal- <br /> EfHAZARDOUS WASTE [2/DAIRY <br /> RrTIERED PERMrnn FACILM' <br /> O'AMV13GRZUND TANK <br /> U�I (MOWTORIW,i KEMOVAL) Um- <br /> 131H1ZARDOUS VIATEPIALS �7jfl <br /> M"SPILUP—CLEASEE RrSPOI,'--- <br /> ffSOLto FACUTY i VEMIULt: 4 E�WATER QUALITY <br /> 2'FoOD FACILITY <br /> E2'POOL!c-1, ff-'ZITE fYI1TI3AT!0K' <br /> DAIRY <br /> [V�////// <br /> LANID USE APIPUCATI ON SACS <br /> SFrTjc;PUMPER TRUCK/ <br /> YARD/CHFmr-AL TOILETS <br /> �W-TEWATER TREATIA ENT PLANT �CUPA <br /> ErHOUMC ABATEMENT 7 <br /> F-1 rOOTEUHOTEL <br /> 211CHICKGN RANCH I DDG KENNEL E2/CUPA-HAZ-MAT <br /> 0 MEDICAL WASTE FgCMTY <br /> E]TATTOO/BODY PIERCING DISOLID WASTE <br /> ffyvAsm TIRE 9 <br /> ffCOMPLAINT <br /> OTHER(PLEAaE sPEC4FY): C AncouwTiric <br /> 10 <br /> " *SOKED AREA-EHD USE ONQ-1 <br /> Rece i ved jm�rW. b Staff Name: <br /> -p — -i- 1-1 L, 2 0 1�jj I Q:,O 2 A 9., 0 9 5 <br />