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M <br />1234 KLEINFELDER 3:14 06-29-2010 <br />DATE RECEIVED '"WO <br />IN COUNTY <br />e Ll 01y' 'E EALTH DEPARTMENT <br />600 East kton, CA 45202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br />LiJ 111 <br />1-i PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS: <br />PHONE (1): .'i / /" r{JJ.) PHONE (2): —��- <br />1 11 <br />LOG NUMBE <br />31 <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Please allow 10 business daya fr15.0a <br />te of a 11eation submittal - *Tentative only -moat be connrmad) <br />CHECK BOX TO EXPEDITE REQUEST-f1EE (C 1 OR C! CK ONLY) - REQUEST PROCESSED IN 3 BUSINE S DAYS <br />SIGNATURE OF APPLICANT DATE 6 aao <br />Specific Date Range of Information Requested: From YACt� <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />��// <br />.0 -UNDERGROUND TANK( UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />POTHER CLEANUP SITE (NON -LOP) (3 FOOD FACILITY <br />ZI LID WASTE FACILITYIVENICLE <br />13 WASTE <br />ifir DERGROUND TANK(MONTORINWREMOVAL) <br />TIRE <br />No <br />1•.1♦ Ift_al\sp=a M 's ".. a � / <br />13 DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br />❑ TIERED PERMTTED FACILITY ❑ MOTELIHOTEL <br />®�lsA�\ <br />Specific Date Range of Information Requested: From YACt� <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />��// <br />.0 -UNDERGROUND TANK( UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />POTHER CLEANUP SITE (NON -LOP) (3 FOOD FACILITY <br />ZI LID WASTE FACILITYIVENICLE <br />13 WASTE <br />ifir DERGROUND TANK(MONTORINWREMOVAL) <br />TIRE <br />❑DOG KENNEL <br />13 DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br />❑ TIERED PERMTTED FACILITY ❑ MOTELIHOTEL <br />"ASTEWATERTREATMENT PLANT <br />❑ PUMPER THUCKIYARDICHEMT <br />❑ TATTOOIBODY PIERCING ❑ LETS <br />�LISPA OTAND USE APPLICATION SITE$ <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMT RECORDS ARE AVAILABLE FOR RENEW - MONDAY -FRIDAY 6:00 AM-S:DGPM - EXCLUDING HOLIDAYS. <br />1. Lit 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 Ole type MUST be selected. Fax to (209) 464-0139 or mail to the address Indicated above Address <br />ranges will not be accepted — for additional asslta�l"trite addr k sea contact the EHD. Applicatlons received after <br />3:00 will be processed the next business day. e'� r. ftE Ae <br />2. The EHD Wil notithea applicant If an EHD files _',y <br />fY PP Y e)<(stgVparept`tor review will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held fora maximum of f five business days for review. Appointments <br />should be scheduled accordingly, <br />3. A Ole that Is actively being worked on by EHD staff may not be Immediately available for review. A new application maybe <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 $105.00 deposit prior to review. <br />EHD USE ONLY <br />