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X <br /> Feb. 9. 2018 4: 34PM ATC SERVICES GRP No. 0623 P. I <br /> NX <br /> ■ <br /> SAN'k'i UINs Environmental Health Department <br /> JOAQ--COUNTY,— <br /> PU13LIC RECORDS RELEASE APPLICATION <br /> Grcatnes,, crows here. <br /> r, 0 C I zi_�"s EHD LOG NUMBER: <br /> APPLICANT: <br /> � 1,2A/) '�ej BUSINESSIAGENCY:- <br /> ADDRESS, n1 yC. 4-le—'2-191 t; cli'ry/sTATEizip. <br /> PHONE (I)- 2C,-) — PHONE(2): Z 0 FAX OR E-MAIL.' t.+-C 0 SSL'r'al" <br /> Please allow 10 business days from date of application submittal for the records to 00 available. <br /> Staffwillconta au o a=oIntment date and time to review the requested records., <br /> SIGNATURE OF APPLICANTV , DATE <br /> 1. List up to ten addresses i pace'5e'Fow. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the a roprIate box(es). At least one file type MUST be selected. Fax to(209) 464-0138,mail to the <br /> address Indicated belowor mail to lnfo(@slccfi(i.com. Applications received after 3:00 pm will be processed the next <br /> husiness day. y <br /> 2. For assistance in identifying the nature and content of r_HD records,please contact EHD at the number noted below- <br /> 3. The EHD will notify the applicant it any EHD files exist. An appointment for review will he confirmed approximately ton(10) <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 /> 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 1$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY FRIDAY 8:00 AM-5:0013M(EXCLUDING HOLIDAYS) <br /> Electronic information: El List Cl Map -Description, <br /> Specific Date Range of Information Requested; From <br /> FNVIRONMRNTAi_ <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> i FILES (Sp6cMc addrassos only,iaddrasG ranges will not be acraptod) EHD USL ONLY <br /> Underground Tank(UST) 3trd9t# Street Namo City <br /> cleanup Site{LGP) <br /> 13101her Cleanup Site(Non-LOP) 12s-o 0 d r-k <br /> DAIKY <br /> 2f-RI,ed Perrnilled Facility k 41' <br /> [14/Abovaground Tank <br /> el LIST (Monitodig�Removal) C <br /> 21110;ordous Mateo'lis *f o <br /> [Wspii I Relea&-a Reeponee <br /> N( <br /> Solid We ate FedlIfy I Vehicle (Y-1 WATCR quAwy <br /> F]Food Facilily n" <br /> El Pool I spaMI-AeA'110N <br /> Oalry 1%Ip <br /> Land Use Appli[ciriar Silas a '11111110 llll�I W No <br /> F1 septic Pumper Truck/ <br /> Yard/Chemical Toilets FEB 0 9 20'13 <br /> [_1 Wasiewaler Tres Imeni Plar t <br /> �Aef 5?14UPA <br /> f-I <br /> Housing Abatement 7 EWR10' NWNTALl1EA.TH ASTIHMIHW <br /> F1 <br /> n Chicken Ranch/Dog Kennel F- CUPA <br /> Mzdioal WIsm Facility e t k_ U8'r <br /> W! C+ V— <br /> Tallooladdy Piercing <br /> SOUD WASrE <br /> Male TJra <br /> Complaint <br /> other(Please Speclfy) t / SITf-) C!ACCOUNTING <br /> Vo Uff <br /> IL <br /> "'BOXED AREA-EHD USE ONLY'" <br /> 1)nk 7O f-E' <br /> kecjevpol by-�".2-11 <br /> 0 Records provided by Staff-PPR Complete. s(aff Neme; EHG 48-OG <br /> R e c e � v e d T l rr ea�F e b, 9. -r2018-' 4. 29 PPN o, 304352051 T 200 468-3420 1 F 209 464-0138 1 wvm_sjcehd.com <br />