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11Ir14/Z011 14:33 8884443080 P_II PAGE 01/01 <br /> RECEIVED <br /> DATF RFCFIVFn SAN J OAU U I N C OLIN I Y EHD LOG MMSER <br /> -4 04 2011 ENVIRONMENTAL HEALTH DEPARTMENT �b3 <br /> ENVIRONMENTAL HEALTH 600 East Main St. StoMon, CA 55202-3U29 <br /> PERMIT/SERVICES Telephone: (209)468-3420 Fax: (209)464-0138 Web:vfwwsjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: QP(/✓$ " pS Z l / 1 <br /> /-' I BUSINESS/AGENCY: <br /> ADDRESS:/.�0 0 V`v r 0 � �CITY/STATE/ZIP: <br /> PHONE(1): f{/S /�-570 PHONE (2): FACSIMILFCe� - Q <br /> T 7A TIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 buainea�days i to of applioalion cubm I •Tonfafivo only-muet bo confirmod) <br /> ❑CHECK BOX TO EXPEDITEUES C O C N <br /> REQLY)-REQUEST PROCESSED IN 3 BUSIN S 0 S <br /> SIGNATURE OF APPLICANT DATE l <br /> Electronic Information ❑List❑ ap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streaks Street Na a City <br /> - ...._ Unit 1 <br /> 2. unitz <br /> at - - <br /> 4. D <br /> 5. 6 ,Nowrlil {/y. <br /> /�pp "5 3cGV5 I <br /> e. <br /> 9 El Units <br /> L0. <br /> nil s <br /> Specific Dale Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES (O�i�ttaSlDr' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT t <br /> LID WASTE FACIUTYNEHICLE <br /> EANTHER CLUP SITE(NON•LOP) r]FOOD FACILITY STE TIRE <br /> ND.RCROUND TANK(MONRORINGIREMOVAL) Doc KENNGL IRY wll�J. <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATERTREATMENT PLANT 11-1(4-'11 <br /> IERED PERMITTED FACILITY ❑MOTEYHOTEL ❑QUMPER TRUCKIYARDICHEMK:AL TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA LAND UaE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5'00PM(EXCLUDING HOUDAYs) <br /> 1. List up to ten addressg4 in the apace above. Select the type(s)of files from the list above by checking the appropriate <br /> tlox(as). At least one file typo MUST be selected. Fax to(2091464-0138 or mail to 1110 address indicated above Address <br /> ranges will nut be accepted-for additional aaeiatance with file addrosces,contact the EHD. Applications received after <br /> 3:DO 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 fur review. Appoinbnents <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$122 deposit prior to review. <br /> EHD USE ONLY <br /> -1 e Itall 41 I fD Zr Cc <br /> E <br /> OTfl9110 <br />