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09/26/2007 22:07 20947520 MCILRATH VALLEY K PAGE 01 <br />IV EHD LOG NUMBER <br />SAN JOAQUIN COUN'T'Y <br />S E P 21 ZO07 ENVIRONMENTAL HEALnDEPARTMENT <br />PAR T <br />Street,600 F_ C95202,3029 <br />ENViR+JNMIEN 1 HEATH Telephone: (209) 468-3420 Fpx: (209) 464-0138 Web. www.sjgov.o <br />pEHrA1T; _-�E�iVICE') <br />PUBLIC RECORDS RELEASE APPLICA ON 14 <br />APPLICANT: 4j� ;_'"i/C� w BUSINESS/AGENCY: - <br />L/ <br />ADDRESS: (� L?Lap r I r - <br />PHONE (1):,•,,, ! f� �- � PHONE (2j: �% 6c� g ��% "� FAMMlILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Plea*@ pilaw 10 bucImma datya from dam of application submittal -"Tentative only - must be oonfinr*d) <br />❑ CHECK BOX TO EXPEDITE REQU T 45.00 F E (CAs�I O CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT , DATE <br />i^(ectronlc Information: Q List Q Map — Deserlption: J <br />PI�MiI�1111Y�Yll�l��lli-I•I li•i�'+�1i1��r111��1111iI��I�Y11111 <br />FILEADDRESSENR USE ONLY <br />$traet0 <br />Street Name - <br />City <br />unit <br />1. <br />2. <br />a' <br />4. <br />( unit 2 <br />unit a <br />` l v1 <br />1 <br />/ <br />Unit 4 <br />6. <br />T. <br />(� Unit 5 <br />8. <br />unit 6 <br />Li"o. <br />Specific Date Range of information Requested; From l - 1/ 1 V % to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDEKGROVNo TANK (UST) CLEANUP SITE (LOP) C3 HmtmG AAATVMEt(T 0 SOLID WAsTc FACILrrYNr;HICLE <br />0 OTHER CLEANUP SITE (NON -LOP) ❑ rOOO FAaLrrY 0 WA` TF TIRE <br />O UNDERAROUNO TANK (MIOMTOMNWREMOVAL) 0 DOC, KENNEL 13 DAIRY <br />C1 HAZARDOUS WASTE GENERATDft 0 CHICKEN RANCH CI WASTEWATER TREATMENT PLANT <br />O IERED PERMITTED FAciUTY C] MOTELMoTEL ❑ Pumpept TRucK/YARWCHEM TOILETS <br />0 TATToUBmy PIERCING ❑ POOL/SPA0 LANG! E APPLICATIDN SITES t <br />C3 MEDICAL WA&m FACILITY 9OTHER (PLEASE SPECIFY) S. /�jl► t,--* 9e- k re >' t Irk u'LT— f'o r'wv <br />WELL AND SEPTIC PERMIT RECOR!AS ARE AVAILARLE FOR REVIEW - MONDAY -FRIDAY 8:60 AM-5:00PM - EXCLUDING HOUDAYS. <br />1. List up to ten addresses in the space above. Select the type(a) 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 mall 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 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 Len (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 EMD staff may not be immediately available for review, A neer 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 $95.00 deposit prior to review. <br />EHD USE ONLY <br />