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F�DID <br /> SAN JoAquiN COUNTY � EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a„H{ 1 4 600 East Main St Stocklon, CA 95202-3029 <br /> EN`JIRCINMEtii- HEA�I� <br /> I 1 phone: (209) 468-3420 Fax: (209)464-0138 Web: www Rjgov,org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLiCANIT. Mjke K BUSINESSIAGENCY <br /> ADDRESS: _.. _ ,.11 3 _. I 'r lA}�t ,�),�I. 3,'/CITYISTATEIZIP' <br /> PHONE1 : <br /> ( I _..— _..._—m .. _ ......._ PHONE(2):_ FACSIMILE: <br /> TEMTA rUE`APPOINTMENT DA fF. Time <br /> (Pleaee 211ew 10 busimess s from Rats of n— ..._-_ __.....___._. <br /> day ppNtationsubmittal 'TMfaSVe oniy-must be conMrmedi� <br /> ❑CHECK RAX TO EXPEDITE REQUEST $715 FEE(C CHFr�N REOUfST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L ,� or-+. --- DATE <br /> ECectronic Information: ❑ List❑ Map- Description: _ <br /> FILE ADDRESS END USE ONLY \/ <br /> Sheet A Street Nairne City -7 /�I .r �„�/ A I *unit 1 <br /> �y.�rd�+a .21a`7/ U+� /71t4r-rl� Cr...�t Sfar:�/rr✓ 9s,�-ro, 9 <br /> 2. .6..rJ4r`ENkdat 3/40 1)4 /Lk' i A �r/�c 9s io I�(lo ElUnit 2 <br /> 3. Ikx,14��/cErtJer . 2 2 g 3 <br /> L " ` / -"61 LA) 841fit' r [3 unit a4. ' <br /> S. �,•i,iUPr West I;('rl, ',/!79,11 A A 4y ['!d Ta'��'', `-9 5'37� D Unit <br /> T. / u <br /> 8. <br /> e. ❑units <br /> 10. <br /> ❑Unit a <br /> Specific Date Ranpe of Infom,AOon Roquested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES _ ----- <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) <br /> aHOUSING ABATEMENT Ll SOI EO WASTE FACILUYNEHICLE <br /> E]OrNER CLEANUP SITE(NON.LOPi jFoot)FACILITY`/A),'/4L{*aH irc%65' F,3 WASTE TIRE <br /> UNDERGROUND TANK(MONITOWNGIREMOVAL.) ❑Doc,KENNEL <br /> U DAIRY <br /> ❑HAdARIbUS WASTE GENERATOR CHICKEN RANCH WASTEWAI ER TREATMENT PLANT <br /> [J TIE RET)PERMI TEDFACILIIY MpIlLIHoIEI. UPUMPERTRUCKIYARDtCHEWCALTOILETS <br /> D TAYI OOIBCIDY PIERCLNG POOLISPA LAMiID USE Ai"PLVCATIDN SREG <br /> Q MEDICAL WASTE FAC'IU.rrY OTHER(PLEASE SPECIFYI <br /> AY �, _ 5:00PM(EXCLUDING HOLIDAYS.) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am AM <br /> t. Litt uo td Ian addresses In the space above. Select OHt type(S)of files from the list above by checking the appropriate <br /> box(as). At least One file type MUST be Selected. Ell to{2091 484A1. 8 or mail to Dne address indicated al7ovrt. Address <br /> es <br /> rangWill not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after <br /> 7:00 pro will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHO files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be hold for a maximum of Ove business days for review. Appointments <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 Avai Mable, <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD$taff at fire oxpense.of the applicant. <br /> Future file reviews by the same applicarit may require a St15 deposit prior to review. <br /> 5. If you need further assistance, please contact Dkine Martinez,at [2091 468-3425 <br /> ITXed reS-��l a ns aX I C441 df, <br /> -9Yj9M114 <br />