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02/05/2010 15: 03 5168516 STANTEC PAGE 01/61 <br /> M � SAN JOAQUIN COUNTY EHD LOO NUrnaER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> B 2010 <br /> Telephone: (209) 483420 Faxst Main : (209)k464-0 38 Web:ton, CA owww.sjgay.o�g/ehd <br /> �fVCRQNN9N HEALTH '00,4w <br /> r-GPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,' BUSINESSIAGENCY:�pr <br /> ADDRESS: ( _ ' & _f ? ..�� CITYISTATEIZIP:� <br /> PHONE (1): PHONE(2): _ FACSIMILE: X14 ${J-t! 3L <br /> TENTATIVE*APPOINTMENT DATE: E ,.�, , a-t l Time: <br /> (Please allow 10 businaas days from date of Appt�cation aubmlttaf-"Tellfefive only-must he confirmed) <br /> 40ElCHECK BOX TO EXPEDITE REQUE -5115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 6U IN .SS DAYS <br /> SIGNATURE OF APPLICANT r .�� � DATE � �f(4 <br /> Electronic Information: El List❑ Map—Description: <br /> FILE ADDRESS EHR USE ONLY <br /> Street Street <br /> Name city <br /> 1. J / B YY 4� x^ 06 dr1 y t <br /> (l� " <br /> 2. <br /> 12 <br /> 3" L/Cr V _ e�!,� 0�1 {�`' MI 6'%,i SIU 60r,?'' <br /> nit 3 <br /> 6. <br /> rill <br /> 7. <br /> - - Elunit s <br /> $. s <br /> 10. <br /> _ ©Unit 6 <br /> Specific Date Range of Information Requested: From to r <br /> ENVIRONMENTAL HF; PCT_H—DEPARTMENT FILES ��11� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) :j HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE � fit <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MCNrTORINGIREMovAL)k ❑DOG KENNEL ®DAIRY f Com[ I <br /> HAZARDOUS WASTE GCNERATUR ❑CHICKEN RANCH ❑WASfEWATCR TREATMENT PLANT -,2-, <br /> ❑TIERED PERMITTED FACILITY ❑,MOTELIHDTEE <br /> []TATTOOIBODY PIERCING POGUSPA ❑LANDPumPER TRUCKICATION SITES TaILETS ZI'�l r1 <br /> ❑ ❑LANs USE APPLICATION SITES 1 1 <br /> ❑ MEDICAL WASTE FACILITY []OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AvAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1" List up to to eddressea in the space above. Select the types)Of files from the list above by Checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 17Q9)464-0138 ortrail to the ad es9 indicated above. Address <br /> ranges will not be accepted -for additional assistance with file addresses,Contact the I;HD. Applications received atter <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An 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 business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHL)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 eamo condition As ralansed will be reorganized by EHD staff at the expense of the applicant_ <br /> Future file reviews by the same applicant may require a$116 deposit prior to review. <br /> 5. If you need further assistance,please contact plane Martinez,at(208)468.3425. <br /> rHo VIE©NLY <br /> _ 10 lk4IVIA. WI ,� �.� <br /> E HO 4U-OG <br /> 8I2T1o8 <br />