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MATT <br /> .t <br /> 3=~ PAGE ' 01 <br /> DATE CEIVED <br /> =SAN'JOAQUIN COUNTY FHD LOG NUMBER <br /> ✓x ENVIRONMENTAL HI=ACTH DEPARTMENT <br /> 600 East -_ <br /> Main Strlret, Stack <br /> i Telephone: (209y 468 3420 F tori; CA-95202-3029 '- <br /> ax; (209)464-01.38 Web:www.sjgOv.Org/e d" <br /> T PUBLIC RECORDS RELEASE APPLICATION ' }' fJ <br /> Y e-'v 4 <br /> APPLICANT: a7r M qL_ <br /> gUSINE35lAC#ENCY:..:Df� irn . Cog [ til �f T' <br /> PHONE(1): f G C1 •'� <br /> tHO'NE <br /> TENTATIVE'APPOINTMENT DATE: FACSIMILE., r !: <br /> (Pleeso-atlow ten business days from date of a plicatnsutrnittal-•Te»fetrve only;Time: � �LI <br /> 0 <br /> CHECK Boz To EXPEDITE BEQUEST_gg pp FEE" ASH OA CHECK ONLY}-REQUEST PROCESSED NcTHREE BUSINESS 4AYS <br /> SIGNATURE OF APPLICANT GI � � <br /> Electronic lnformatton; L€st❑ M - `.pAT� �^`f�--� ' �• i <br /> ❑ ap-Description: <br /> - FILE ADARESS <br /> Street# Street Name —` EHD USE ONLY <br /> 1•...1 t30 ";� � _ + � <br /> ln.l f L.SU�/ <br /> Unli <br /> (,z)[A•r o <br /> C Cf Uti/ Untt3 <br /> 7. w _ u}^ �.-•"'GtC • — .. U nit 4 <br /> r � <br /> 91fl,}llnit <br /> 5 <br /> 10. <br /> JP <br /> Specific Data Range of inforntat€on Requested:From � <br /> n to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUROERGROLIND TANK(U$T)CLEANUP SITE(LOP) ID HOUSING ABATEMENT .,*❑SOLID WASTE t ACILITYNEHICLE <br />'4 OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY' + C7 WASTE TIRE <br /> Ptr UNDERGROUND TANK(MONlTORINGIREMOVAL) {�Doa KENNEL r ❑DA ST <br /> HAZARDOUS WASTE GENERATOR RY <br /> CHICKEN RANG{ ' 0WASTEWATER TREATMENT PLANT <br /> ,kf43- <br /> TIERED PERMITTED FACILITY '" ❑H CMUHOTEL" ❑PU*PER TRUCKfYARdfCHEM TOILETS <br /> El TATTOO/BODY PIERCING " C'J POOLISPA '�I � '❑LAND USE APPLICATION ITt;S{ <br /> ii <br /> Q ME�€CAL WASTE FAGIi K ©OTHER(PLEASE SPECIFY) ✓rel!>R�NIi �L41 Ts.. f]i YPC4$E i <br /> WELL ANDSEPTIC PERMIT RECORDS ARE AVAILABLE FDR REVIEW - MONOAY-FRIDAY Sapp AM-$:00pm - EXCLUDING 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 lea&t one fife type MUST be Selected. Fax to 249 464-0138 or mail to the ab"ov dregs. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be procegsed the next business day.` <br /> Z The EMD will notify the applicant if any EHD tiles exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application, The files 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 the EHD staff may not be Immediately available for review. A new application <br /> may be submitted when the file is available, .- - - <br /> 4. Any file not returned in the same condition as releared will be reorganlzed by EHD staff at the Expense bf the applicant. ' <br /> Future file reviews by the same applicant may require a $98.00 deposit prior to review. <br /> n¢ IEHD USE ONLY <br /> s r o aa-0u 10179r07 PUs;IC RECORDS RELEASE APP FORM <br /> I <br /> fI <br />