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62/11/2810 17:14 3125416340 PAGE 01/01 <br />� �� 0 <br />I�LJVVrFD <br />0�?6EJEIYEa 010 SAN JOAQUIN COUNTY EHD LOG 14tIM6ER <br />ENVlROfENT HEALTH ENVIRONMENTAL HEALTH DEPARTMENT <br />PERMITISER�Il�kS� � 0� o l=ast n�airi Sl:. {8to) ton, CA 95202-3029 1g <br />elephone: 209 458-3420 Fax: 209 464-0138 Web: www.s ov.or1ehd 0�_5]p <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: E r,' 4- J- e r' �z. BUSINESWAGENCY: cr"+ •'� rte{ r- h r <br />ADDRESS: -2041 rk 41, SES !Ir 5 -41 -�6'o CITYISTATEr-LIP: ��' "Ado X71- 6�6� <br />PHONE (1): 312-r'-11- 72-23 PHONE (2): FACSIMILE: <br />TENTATIVE'APPOINTMENT DATE' Tirne° - <br />(Please allow 10 business days from date of application submittal-'Terdativa only • must be confirmed) <br />CHECK SOX TO EXPIWDITE REQUEST • 5115 FEE (CASH OR CHECK ONLY) • REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 7- <br />Electronic Information: ❑ List ❑ Map Description: <br />FILE ADDRESS . EHD USE ONLY <br />Street # street Name City © Uni <br />1. 57'yo0 <br />- [] unit z <br />2. <br />rQ_ URlt3 <br />Unit 4 <br />7. <br />8. _ ❑ Unit 5 <br />9. <br />Unit 6 <br />Specific Date Flange of Information Requested: From to -. <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />OWUNDERGROu" TANK (UST) CLEANUP SITE (LOP) [I HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE �1 <br />Q OTHER CLEANUP SITE (NON -LOP) [] F DOD FACILITY ❑ WASTE TIRE vx ! <br />UNDERGROUND TANK (MQNIToRiNGJREMoVAL�— Q DOG KENNEL r0DAIRY 'p43 Z/N16 <br />HAZARDOUS WASTE GENFRATOC)' 71 CHICKEN RANCH U WASTIWATER TREATMENT PLANT <br />Q TIERED PERMITTED FACILITY Q M0TE1JH0TEL ❑ PUMPER TRUCKIYARDICHEMCAL TOILETS <br />[] TATTOOIBODY PIERCING [] POOLISPA 0 LAND USE APPLICATION SITES <br />Ll MEDICAL WASTE FACILITY © OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />i. List ue to te_n 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 assistance with file addresses, contact the EHb. Applications received after <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 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 $115 deposit prior to review. <br />5. If you need further assistance, please contact Diane Martinez, at (209) 468.3426. <br />EHO USE ONLY <br />