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1234 GATE RECEIVED KLEINFELDER -3;14 06-29-2010 1/1 <br /> � (pPp 1N COUNTY EH LOG NUMB <br /> y�d�e011TATEALTH DEPARTMENT <br /> Szt. ckton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/eh <br /> ,.I PUBLIC RECORDS RELEASE APPLICATION r <br /> APPLICANT: C1 BUSINESS(ItAGJE�N.cy:: <br /> ADDRESS: `.�L� CITY/STATEMP <br /> PHONE(1): _ J TI' '/'4321 PHONE(2) <br /> TENTATIVE'APPOINTMENT DATE: Timor: <br /> (Please allow 10 business days fr data of aIlcatlon submittal-•Tentative ony-must be coldirmed) <br /> r rHECK BOIL TO EXPEDITE REQUEST-$1 S. 0 EE(C OR C CK ONLY)-REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT _ DATE .ZQO <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street a street Harm city <br /> 2. 9y :50h 5)p�lpnI At <br /> 3. ©E5, / unnz <br /> (o ! i <br /> 4' �6U � � ugh a .X <br /> U 5 /' <br /> g. O unit e <br /> T. 0l t1Q <br /> B. Unit 5 <br /> g 10. iUnit 6 <br /> Specific Date Range of Information Requested:From _���'s-TtC to <br /> � ENVIRONMENTAL HEALTH DEPARTMENT FILES h� <br /> .0UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 135LE0LIO WASTE FACILITYNEHICLE <br /> PIDTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY C)WASTE TIRE IWI 1 <br /> DERGROUND TANK(MOMTORINGRREMOVAL) O DOG KENNEL 0 <br /> NAARDOUS WASTE GENERATOR 13CHICKEN RANCH OVASTEWATER TREATMENT PLANT y,T✓ /I/�O <br /> 0 TIERED PERMITTED FACILITY O MOTEUHOTFL O PUMPER TRUCKNARD/CHM TOILETS YYY <br /> O TATTOOIBODY PIERCING 0POOLISPA ,L31—AND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAY& <br /> 1. List up to ten addresses In the space above. Select the type(s)Of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 2091464-0138 or mail W the address Indicated above, Address <br /> ranges will not be accepted-for additional assIstapct witVIIIAOd7geSgOntact the END.Applications received after <br /> 3:001 m will be processed the next business day. L� <br /> 2. The END will notify the applicant if any END files exist An appointme11 nt for r6)r w Will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum Of five b`slness days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A life 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 END staff at the expense of the applicant. <br /> Future flit reviews by the some applicant may require a$105.00 deposit prior to review. <br /> END USE ONLY <br /> """If need further assistance lease contact Dion Martinez @ (209)168-3425 directly. Thank You""" <br /> - © : <br /> - <br /> -D: 4 (V <br /> P d !( adAA$OIl�j2 <br /> 1-1-10' VfDd OM 047t 0 t-OP�O f CD 318" UJIFifm and CM)O { :n 9L1Ll Y 2� <br />