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-234-0538 Line 11 `xa.m. m-as-zolaAN 1 /� <br /> U De��� <br /> DATE SAN |�� COUNTY '---' <br /> 0m <br /> RECEIVED ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> � � �lt� 1888 East Hazelton Avenue, Stonk±oD, CA 95205-8232 m <br /> ~~ ' = � ����ephone: (209)488-3420 Fax: (7OS)404-0138Web: www.sjgov.org/ehd |� <br /> EURONMENTALIJEAM <br /> PERMIT/SERACES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: b!�Z��177_ BUSINESS/AGENCY: e��d_ �b <br /> CITYISTATEr <br /> PHONE(1):4. <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> F-1 CHECK BOX TO EXPEDITE R:EQUW CHECK ONLY)-REQUEST PROCESSED IN 3 BUSI ESS D <br /> SIGNATURE OF APPLICANT. Wz= DATE <br /> Electronic Information: 0 List 0 Ma'p—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 42 <br /> j t7 <br /> 8. -*qc To view the HMMP(Hazardous <br /> fqq Materials Managem@ht Plan)go to the [I Unit 5 <br /> 9. following website:www.sjoesdata.org <br /> ` <br /> Specific Date Range ofInformation Requested- From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> . � <br /> — -- HOUSING ABAocMsNT---�______-' 5ouoVUxsrsF -^ <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY <br /> WASTE TIRE D <br /> VLUNDERGROUND TANK ow DOG KENNEL DAIRY yr <br /> JRHAZARDOUS WASTE GENERATOR 0( 0 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY Oe- Mo7cUHuTsL PUMPER TnocK0Ano/Cxsm|oxLTOILETS <br /> TAnnu/BUnvP|cemms PooLI5px OLAND USE APPLICATION SITES <br /> Fl MEDICAL WASTE FACILITY COMPLAINT RECORDS []OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW: MONDAY-FRIDAY13:00AM-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 assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 prn will be processed the next business day. <br /> 2. The EH0will notify the applicant|yany EHOfiles exist. Anappointment for review will beumnfim«edapproximately ten(1O) <br /> days after receipt ofapplication. The files will beheld for amaximum offive business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. Afile that is actively being worked on by EHD staff may not be immediately available for review. Anew application may be <br /> submitted when the file{savailable. <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 i by the applicant moyr quiraa$125dapna(tpdortorevow. <br />