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EHD'LOG G NUMBER <br /> DFNh6k-�'V SAM JOAQUIN COUNTY <br /> O -TH DEPARTIAF=�T RONIVIENTAL HEA1 <br /> JUL 9 7 1868 East Hazelton Avenue, Stocidon, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:vvww.sjgov.org/ehd <br /> 13M RONMENTAL Vr-P—TV PUBLIC RECOROS RELEASE APPLICATION <br /> A,T -ER=ES <br /> PLICANT: f VBUSINESSIAGENrCY: <br /> CITY"ISTATEIZIP: Illkf\A�, I <br /> ADDRESS: <br /> PHONE (1):(ilo (2): FAK CR E-MiA L: <br /> Please allow 10 business days from date of appkation sUbiltlittal for the records to be available. <br /> Staff V411[contact you to arrange all appointment date and ikile to review the requested records. <br /> [:] CHECK BOX TO EXPEDI E VEQUEST-$,13t) EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> I bt DATE ' Aate <br /> 1. List up to ten addresses in he space h,61ovy. Select the types) of files from the list below by checking the epi Address <br /> At least one file type%r(UST be selected. to the address indicated above <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 witi be heid for a maximum of five business days for revievii. Appointments <br /> should be scheduled accordingly. <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 $130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIE'Al: MONDAY-FRIDAY 6:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> Electronic- Information: El List El Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> E-_NV[RO N TO E NTAL <br /> HEALTH DEPARTMENT ME ADDRESS END USE ONLY <br /> FILES <br /> _ff;JNDEPOROUNo TANK(LIST) Street# Street Name City �No ❑CONrUTAER <br /> cufOLFANUP SITE(LOP) S�01 <br /> BOTHER CLEANUP SITE(NON-LOP) -vt L/ <br /> � <br /> DAIRY <br /> STE'HAZARIDCIUS WA <br /> VI.E'RE,11 P15RV1,7TE"D.FAciLi <br /> ut <br /> 'V i .... T K FVVS <br /> OV <br /> VUST (MONITORING I REM q 5 i I�ej 0 ca_�110 <br /> 21HAZARDOUS MATERIALS 4 11 <br /> [L'&ItJREL5ASE RESPONSE <br /> a-'AIATER QUALITY <br /> E?rSOLIO WASTE FACILITY I VEHICLE 4 �S3 <br /> F-1 FOOD FACILITY :.]/Sl7E MITIGATION <br /> F_­]POOL/SPA <br /> F-1 DAIRY <br /> GLAND USE APPLICATION SITES El Houslr,* <br /> F-1 SEPTIC PUMPER TRUCK 1 6 <br /> YARD/'CHEMICAL TOILETS <br /> 2WfASTEWA7ER TREATMENT PLANT El'CUPA <br /> F7 HOUSING ABATEMENT 7 <br /> F]MOTELIHOTEL L]/CUPA-HA2-MAT <br /> F-1 CHICKEN RANCH/DOG KENNEL <br /> F-]MEDICAL WASTE FACILITY <br /> F-1 TATTOO/BODY PIERCING 2'sOLID WASTE <br /> VWASTE TIRE <br /> COMPLAINT AcCOUN7;NG <br /> F-]OTHER(PLEASE SPECIFY): 10 <br /> _'BOXED ARTA-EHD USE ONLY­ <br /> CQ1 <br /> T <br /> H Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />