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1234 KLEINFELDER 3:14 06-29-2010 111 <br /> DATE RECEIVED EH LOG NUMBE <br /> NONA IN COUNTY <br /> 4 <br /> c , ' / MENTAI`��=, . EALTH DEPARTMENT <br /> 600 East IV(a`tn St. nekton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web: WWW.Sjgov.org/eli <br /> PUBLIC RECORDS RELEASE APPLICATION - <br /> APPUCANis BUSINESS/AGENCY: Q\ `,\Co/ <br /> ADDRESS: CITY/STATE/ZIP C - <br /> PHONE(1):- PHONE(2): FACSIMILE: �J / <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days frdate of a Ilcation submittal-*Tentative only-must be confirmed) <br /> AIR <br /> CHECK 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 aGo <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street k Street Name ---- <br /> ---- City / 7✓J ' <br /> nit 1 <br /> ��—'L _ a-Cj� �` Unit 2 <br /> -3'-- (°__ - ,�` ` <br /> 4' _o�� ��jy - Unita <br /> 6. Unit 4 <br /> 7. o to <br /> 8. -���`----- Unit 5 <br /> G <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESJ� <br /> .r�y UN.�DERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT RTSOLID WASTE FACILITYNEHICLE `{' <br /> /�OI HER CLEANUP SITE(NON-LOP) CJFOOD FACILITY 0 WASTE TIRE I` <br /> DERGROUND TANK(MONITORING/REMOVAL) 171DOG KENNEL ❑DAIRY <br /> I Q <br /> VHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH O'WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTEL/HOTEL Cl PUMPER TRUCKNARD/CHEM TOILETS <br /> ❑TATTOOBODY PIERCING 0 POOLISPA 0_CAND USE APPLICATION SITES <br /> d MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <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(209)464-0138 or mail to the address Indicated above Address <br /> ranges will not be accepted-for additional assIstap,"VeAvidpwses contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. * hp fir <br /> 2. The EHD will notify the applicant If any EHD files exist,IAn appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five 66siness 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If ou need further assistance lease contact Diane Martinez @ (209)468-3425 directl . Thonk You*** 5 i5 <br /> wivt _ , cin DJ(o(� d a�``$pi132U <br /> -i e10, Pro u•. it,int (2co 31 <br />