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i 03/07/2013 12:02 FAX. 805 964 I URS Corp Santa Barbara IM0001/0001 <br /> DATE RECEIVED EHD LOG NUMBFR <br /> \ SAN JOAQUIN COUNTY <br /> 7rta 'y!L <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1 <br /> 1868 East Hazelton Avenue, Stocktorr, CA 95205-6232 <br /> �T�Iophane: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd- <br /> 8 <br /> ,,; 4 `PUBLIC RECORDS REL_EASE APPLICATION <br /> 9,0 <br /> APPL[C�NT ':1�. CJ ��11i r ' f'r�CC11� BEISINESSIAGENCY: VR� C_ XA-TJO <br /> _ADDRESS:'�D �Pjl.iJ 4L1Db CITYISTATIJaP: <br /> PHONE(1): D(05 P' OE'li2)i n x ��jd � q4p4'' qFACSIMILE: 7 <br /> TENTATIVE*APPOINTMENT DATE: i Time: <br /> (Please allow 10 business days from data of application subraftlal-"Tentative only-must be confirmed) <br /> ❑ <br /> CHECK BOXTQ EXPEDITE REQUES4 S125 F CA)hi OR ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT //(m _ DATE •� 7/ 3 <br /> Electronic Information: ❑ List❑Map;.-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name city ❑Unit 1 <br /> �- V �. . ..•(r ©Unit 2, <br /> 3. <br /> X-41 <br /> 4• Unit 3 <br /> $. E nit 4 <br /> f <br /> 7. <br /> $. ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From: : to <br /> ih ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �DERGROUND TANK(UST)CLEANUP SITE(LOP) ElMEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> WPDERGROIJND <br /> ER CLEANUP SITE(Nom-LOP) [j HOUSING ABATEMENT ❑WASTE TIRE <br /> TANK(MONITORINGIREMOI/AL) ❑FOOD FACILrTy ❑DAIRY <br /> MOVEGROUND TANK [].CHICKEN RANCHI DRG KENNEL ❑WASTEWATER TREATMENTPLANT <br /> �AZARfl0U5 WASTE1HA7ARDOUS MATERIALS ❑MOTELIHOTEL ❑ U UCK/1fARDICliEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑P LISPA E]LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING pLAINTIRPSPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERmiT RECORDS ARE AVAILABLE FOR REVIEW: 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 /> box(es). At least one file type MUST be selected. Fax to{200)464-0138 or mail to the address indicated above, Address <br /> I� ranges will not be accepted-for additional assistance with file addresses;contactthe 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 confirrtled approximately ten(10) <br /> r days after receipt of application. The files will be held fora maximum of five business days far review. Appointments <br /> should be scheduled accordingly. <br /> k. 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 /> f 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$126 deposit prior to review. "`"BOXED AREA-END USE ONLY*` <br /> I _ <br />} �HO>tdd6 W911 <br /> i Received Time Ma-r. 7. 2013 11 : 54AM No, 2511 <br /> 5 <br />