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• • • - . •�v� ruu � � � it ryU LVNUMtlk <br /> (� `\ n SAN JOAQUIN COUNTY <br /> tIi <br /> WECCEOvED� ENVIRONMENTALHEA.LTHDF,,PARTMENT <br /> 304 East Weber Avenue, 3r 0TI CA 95202-2708 <br /> MAR 7005 Telephone: (209) 468-3420 Fax (209) 464-013 Web: www-sjgov. org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RE, coRDS RFLFASF, APPLICATION �d <br /> APPLICANT: <br /> BUSINESSlAGENCY: �.,.T, <br /> ADDRESS: .�/>.,( f <br /> PHONE (1): {/�_., ��'�t� r'rPHONE <br /> TENTATIVE" APPOINTMENT DATE: SSU Time: <br /> (Please allow 10 business days from date of application submittal - "Tentative only - must be confirme _d) <br /> 13 CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE (CASH OR CHECK ONLY) — REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � ) - <br /> UNIT DISTRIBUTION 0 Unit 1 0 Unit 2 ❑ Unit 3 nit 4 0 Unit 5 El Unit 6 ❑ Other (etectronionistWmaps) <br /> FILE ADDRESS <br /> Street tF EHD USE ONLY <br /> Street Name city <br /> 1 . /1 <br /> 26 <br /> 3 . <br /> FP <br /> 10:- 1 / / Lc �2u_C sw <br /> A) f <br /> Specific Date Range of Information Requested: From z � / _ e ej , to A3 a� 4 7` ` <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I:] UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ADATEMENT 4 SOLID WASTE FACILITYNEHICLE <br /> ek0 OTHER CLEANUP SITE (NON-LOP) ❑ FOoo FACILITY d WASTE TIRE <br /> UNDERGRONND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR OCHIQKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY D MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOIRODY PIERCING 0 POOLtSPA �0y LAND USE APPLICATION SITES <br /> ❑ MEOICAL WASTE FACILITY J<OTHER (PLEASE SPEOIFY)� 1 "/k /! e r/`�py_���' R user <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVALABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS, <br /> 1 . List up tD ten addresses In the space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted — for additional assistance with file addresses, contact <br /> the EHD. Applications received after 3:00 pm will be processed the neat 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 he 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 <br /> applicant Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> EHb A9-02006 <br /> „/z�ma <br />