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"inn. I CVVV C ilrlyi WNM EAKIH IECH <br /> ;IF V( NO. 5926 P. 2 <br /> ,SANJOA.QUIN COUNTx EHD LOG NUMMR <br /> �t�,I LJL'D ENVIRONMENTALHEALTH DEPAPTmENT HEALIH 304 East Weber-3420F, :(209) 64.01 8Web:A ww.sjg95202-2 70 <br /> v.Or 253 <br /> C`` Telephone:(209)468-3420 Fax: 209 464.0138 Web:wwwsjgov.org/ehd� <br /> PEEP,-1f!;�,Lp /1 ._„ ( ) (((.....������,,,,,,,,,,,, *7 <br /> PUBL C RECORDS RELEASE APPLICATION <br /> APPLICANT: 14 <br /> SIN AGENCY; <br /> ADDRESS: It <br /> 0M <br /> 17Y/ ,,rr <br /> PHONE(1): '. �h`�7S ^,PHONE(2): .2p9- Or.. <br /> FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: d lI 1 i3oPff1 <br /> (Please show 10 business days from d D Time: <br /> aY -canon submittal- TenlaNvo only-must be conflnned) <br /> CHECK BOX TO EXPEDITE RE T.S93.0 FEE( CHECK ONLY)-REQUEST PROCESSED IN I 9U INESS DAYS <br /> SIGNATURE OF APPLIC T <br /> DATE Q� <br /> UNIY bISTRIBUTION ❑Unit1 gUnit2 ❑Udlt Unit4 ❑Units O UnNE ❑ other(elaetronicnists/maps) <br /> FILE ADDRESS <br /> Sleet# sheet Name Ih EHD USE ONLY <br /> y 0 <br /> Y XM( <br /> 3, p 1 u <br /> 4. s 1.l <br /> I <br /> 7. <br /> 10. 20 <br /> Specific Date Range of Information Requested:From <br /> _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES( )NDEROROUNOTANK(UST)CLEANUP SUE LOP ❑ <br /> MER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY MEN7 $OLIO wq$TE PACILfTYNEXICLE <br /> ni-IIGli <br /> NDEROROUNDTANK(MONITORING/REKOVAL) OCOG KENNEL ❑WAM TIRE <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN NEL ❑DAIRY <br /> TIERED PERMUTED FACILm' ❑CHICKEMOTELIN <br /> ❑WASTEWATER TREATMENT PLANT <br /> Cl TATTOOIBODY PIERCING OM <br /> q POOLISPA ❑PUMPER TRUCK/YARD(CXEM TO(LET3 <br /> 0 M201CAL WASTE FACIUTY OTHER P LAND USE APPLICATION SITES <br /> WELL AND SEPTIC PERMIT RECORDS AP.E AYAILADLE PoRREYIEA(PLEASE <br /> MONOAYFPJOAY 8:00 Am =FN . EXCLUDING HOUVAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate ove(es). At least one file type MUST be selected. Fax to 209 4G4-0138 or mail to the address <br /> Indicated above Address ranges will hot m will a pr—for additional assistance with file addresses, contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as refeased will be reorganized by END staff at the expense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> Y <br /> END i 2L 4 <br /> t/t4D5 <br />