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1234 KLEINFELDER '4 14 06 29 2010 <br />DATE RECEIVED <br />T <br />EH LOG NUMB31 <br />IA IN COUNTY <br />TL`N�-VlI ONMENTALLa EALTH DEPARTMENT <br />600 East lain fit. ockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br />PUBLIC RECORDS RELEASE APPLICATION <br />i4RPUC�1Ni �� <br />PHONE (1): <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Please allow 10 business days fr date of a Iication submittal -'Tentative only -must be confirmed) <br />HECK BOX TO EXPEDITE REQUEST - $1 5. 0 EE (C OR C CK ONLY) -REQUEST PROCESSED IN 3 BUSINE S DAYS <br />SIGNATURE OF APPLICANT DATE a Sao <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From - e ' yywYc. <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />,,/ <br />JZ --UNDERGROUND <br />Ja UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 13 HOUSING AB <br />P -OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY <br />RATEMENT SOLID WASTE FACILITYNEHICLE <br />❑ WASTE <br />1 "I <br />gGDERGROUNDTANK (MONITORINGIREMOVAL) ❑ DOG KENNEL <br />TIRE <br />❑ DAIRYEl <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br />O -WASTEWATER TREATMENT PLANT <br />�t <br />�`/J.i <br />❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL <br />❑ TATTOO/BODY PIERCING ❑ POOLISPA <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />g-CAND USE APPLICATION SITES <br />✓ <br />❑ MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM•5,00aM - FYri rrraur. Flni in.ve <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 to the address Indicated above Address <br />ranges will not be accepted —for additional asslsta t ile are ses rntact the EHD. Applications received after <br />3:00 pm will be processed the next business day. s <br />2. The EHD will notify the applicant if any EHD files exist �An appointment for revl'ew will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held for a maximum of five 6Usiness days for review. Appointments <br />should be scheduled accordingly, <br />3. A file that is actively being worked on by EHD 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 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 />'If you need further assistance please contact Diane Martinez � (209)468-3425 directly. Thank You*** <br />COM 00 <br />an <br />P _ c _ <br />Emo 48io Prof, 0/110,,, Q �P}o a f co 3�5� o� FN��� a nd a f✓bo8y�� quu sio � <br />