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Feb. 2.. 2016 1 ;49PM Ifo, 2355 P. 2 <br /> DATF_ EHD LOG NUMBER <br /> RE <br /> SAN ;JOAQUIN COUNTY' <br /> CENED, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ��--��—��e 'i.86$-E-est HazeGtanAvenue;Siockton�GA 9��05--622 - �-- <br /> �. T416phone: (209)4684424 Fax. (200)464-0138 Web: www.sjgov.org/eh'd <br /> E iR0NtAF 4TAL'HEALrr§ t <br /> PrERNOTISERVICES PUBLIC RECORDS RELEASE' APPLICATION <br /> IIt APPLICANT: 'f 1 VlC j [ BUSINESSIAGENCY.-',E,T C0U-r ttD( (6 W00eG ' <br /> ADDRESS: �. CITY/STATEMP: `(DV1 � } �5 2.U6 <br /> PHONE (1): PHONE (2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment tate and time to review the requested records. <br /> -6-6....... ........ .....T _REQUEST - ---C - _. �'7. _�. .-_ ---- ------ <br /> _ -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> ❑_CFiECKBOX.l"0 EXPEDITE REQUEST-ffi130 FEE CASH.�F��CHECK ONLY) - _ - <br /> SIGNATURE OF APPLICANT DATE 242,[10 <br /> Electronic information: ' ❑ List ❑ Map—Description, <br /> FILE'ADDRESS <br /> EHO USE ONLY . <br /> I Street# Street Name city <br /> 300nv S W(dpri tzd <br /> ✓ <br /> 2 Unit 1 <br /> �19lot, S S' 4 Way <br /> w -Wf ac <br /> 3' 305D5S jr U't� l/If i�l�nit2 <br /> r : <br /> 4. a u9v P �Sn ??��nPr��Y` 1 1� A) : .11J R 4,- unit 2H T�j a <br /> t r 5. Ir <br /> 1 11111 VV �Ii�C-� a ra 0 .N0 L�JU,it3 <br /> A 0 r ; nit 31dM <br /> f2102- W �UDit4 <br /> G ( l! IT 7 TIDN <br /> I11 tD. S lei 3L �(� <br /> s. r�3C?Q S T1Z{ �114 4 fiL &Mol md)6j)do <br /> �0%' <br />' 's _TV� ' ' '� j{ ©unit 6 <br /> t SpaclRc Dace Range of InfoDngtion Requested: From to <br /> HEALTH _DEPARTMENT to <br /> _ L RTMENT FILES <br /> I` 2 UNDERGROUND TANK(UST)CLEANUP SITE(LOF'} ❑N10TELIHO7ELSOLID WASTE FAGLI EH1CL <br /> ©OTHER CLFIINHP SITE(NON-LOP) 9-I LOUSING ABATEMENT ❑.FOOD FACILITY <br /> r ❑llNDERGIZOIIND TANK(MONFORINWREMOVAL)01� [aVNASTE TIRE [ DAIRY,POOLISPA 1,L/4 <br /> ErABOVEGROUND TANKO( CHICKEN RANCHI DOG KENNEL I��+ / <br /> • - QrHAIARi]OUS WASTE I?� c[]'WAST"EWAT�Ii TREATMENT PLANT �,?..[,�-1�0 <br /> ❑MEDICAL WASTE FACILITY. O'PUMPr-R TRUCKIYARDICHEMICAL TOILETS <br /> ti a.HAZARDOUS MATERIALS ElTATTo01BODY PIERCING E21_F NO USE APPLICATION SITES <br /> [TIERED PERMITTED FACILPV<, L31COMPLAINTIREsPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> - WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIP.w: 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 /> s 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.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 reaoMs., please contact FHD at the number noted above. <br />} 3. The EHD will notiry.the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(t o) <br /> days after receipt of application. The riles will be held for a maximum of five business days for review. Appointments <br /> should be.scheduled accordingly. <br /> Q. Any file not retumad In the same condition.as released will be reorganized by EHO staff at the expense of the applicant. <br /> Future Lrle reviews by the same applicant may require a$130 deposit prior to review. <br /> -' BOXED AREA-EHD USE ONLY** . <br /> ' o <br /> bV�jd 0 <br /> to ama: <br /> Received Time=Feb, 2, 016= 1 44P <br /> =2 ; M=No. 0434 <br />