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09/13/2010 08:37 80522 09 SIERRA DELTA CG,_,,�,-T PAGE 01/01 <br />EHp LOG NUL413FIa <br />V <br />GATE REGf,� SAN .)OAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. StQAkten-eR9 202-3029 <br />Telephone: (209) 468-3420 Faxr9) 464-013 eb: wwW.sjgov.org/ehd <br />�7 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: yj-�ke c BUSINESSIAGENCY- 5 Q <br />ADDRESS: 1N'- '�c_2A CITyISTATFJZIP:PHONE (1): S.!; °t.LFi52 PHONE(2): FACSIMILE:@n5.V31, q p`al <br />TENTATIVE' APPOINTMENT DATE: Time' <br />(Please allow 10 business days from date of application submittal - OTeoNdre only . must be confirmed) <br />❑ CHECK BOX TO EXPEDITE RE�QUESAw T .� $�1_15 FEE, , <br />(CASH OR CHECK ONLY)- REQUEST PROCESSED N`3BUSIIN SS DAYS <br />SIGNATURE OF APPLICANT Y ` ! <br />u— <br />r�^ <br />Electronic Information: <br />❑ List t5lilikilp – Description: <br />FILE ADDRESS <br />EHD USE SE <br />nn 1 <br />SVaHN Sime) Name Cay <br />1. j}vfo <br />QgZA �A <br />a•' 011111 <br />' <br />Una 2 <br />2, <br />rj o..%cln 1rcro. <br />3. (035 <br />nit 3 <br />4. <br />UnHA <br />un" s <br />6, <br />7. <br />g, <br />Una 6 <br />10. <br />Specific Data Range of Information Requested: From to <br />J ENVIRONMENTAL HEALTH DEPARTMENT FILES /1 b! <br />OQ NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ARATEMENT ❑ SOLID WASTE FACILRYIYEHICLE [_ , // <br />THER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE M,+3. IV'6 <br />NOERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY /�//O <br />OOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT RANT <br />TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUAtpER TRUCKNARWAEMICAL TOILETS <br />] TATTOOBOOY PIERCING CJ POOIISPA ❑ LAND USE APPLICATION SRES <br />] MEDEXWA$TEFACIL(TY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMfT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-S:OOPM (ExCLUDING HOLIDAYS) <br />1, List up to ten addresses 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 (2091464-0134 or mail 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 />3:06 pm will be processed the next business day. <br />2. The EHD will notify the applicant If any EHD flies exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. Thu 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 END staff may not be Immediately available for review, A new applkaUon may be <br />submitted when the file is available. <br />4. Any file not returned In the same condition as released will be reorganlxed by EHD staff at the expense of the applicent- <br />Future Me reviews by the same applicant may mgalre a $115 deposit prior to rsvlaw. <br />5. D you need further assistance, please contact Diane Martinez, at (209) 468.3425. <br />