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05/10/2006 09:54 9164463803 HAT T <br /> PAGE 01 <br /> DATER CEIVED <br /> LOG NUMBER <br /> SAN JOAQ� <br /> F—NVIRONMENTALDEPARTMENT <br /> 38 Web: wv,w.sjgay.org/e 600 East Main Street, C'/A 95202-30 �f7 <br /> 29 <br /> Telephone: (2D9)468-3420 Fax. (209) 464-)! g/e <br /> PUBLIC RECORDS RELEAS'PE APPLICATION <br /> APPLICANT: M, <br /> BUSINESSIAGIENCY- DtL-- 'cM"M <br /> �ku E� <br /> 1,OC <br /> ADDRESS: 7_L(_ L/ q4_j�_ 3_0 119 1 5'1C'z4^'(qV�-0 �el <br /> c. <br /> PHONE(I):_qft q-Lt._L &_ �L= <br /> - 3eu:5 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE. 5- e Tirne' <br /> (Plesso allow len business days from date of applicailoh_A-hmittal-*Tentative only mast"atba c9offrmedl <br /> W <br /> CHECK BOX To EXPEDITE REQUEST-$9 00 FEE ASH OR HECK O -Y)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: Ej List E]MRP-Description: <br /> FILE ADDRESS <br /> Street Name _______�HD USE ONLY <br /> Y' 0 unit I <br /> (305T_0(_+ t,_j <br /> (1,50 ev way <br /> -1-1.-C <br /> Zn unit <br /> J9 y 5rOCK7-0.0 >? �77 <br /> 4. <br /> 7_0 C lic 7 0 q,50UnK3 <br /> Unita 3 <br /> 4nit4l <br /> 7. <br /> A14 <br /> 9. <br /> I OLEl unit 6 <br /> Specific:Date Range of Information R"utsted; From /3 to <br /> P2 56+1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XONDIRGROwiD TANK(UST)CLEANUP SITE(LOP) 11 HOUWNG ABATEMENT 0 5QLID WASTE FACILITYIVIEHICLE <br /> XOTHER CLEANUP SITE(NON-LOP) In FOoD FACILsry M WASTE TIRE <br /> UNDERGROUND TANK(MONITORTNIGIRFMOVAL) Zn DOG KENNEL M DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0'TiERED PERMITTED FACILITY M MOTEUHCTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO/BODY PtElRmNo 0 POOLJSPA LAND USE APPLICATIONSn'SS. <br /> 0 MEDICAL WASTE FACILITY C OTHLR(PLFASE SPECIFY) (L_99�D TF W9F (7(4�E <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE�OR REVIEW E�AEVY - MC)Nt)A(-FFZ?I)AYS:ODAm-S:Oopm - EXCLUDtNGHOLI[)AYS. <br /> 1. List up to ton addresses in the space above. Select the We(s)of file i from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to(209)464-0128 or mail to the jk2yLACjdress. Address ranges will <br /> not be 41CCOPted-for addlVonal assistance with file addresses,cents the EHD_ Applications received after 3-00 pm will <br /> be processed the next business day. <br /> 2. The EHO will notify the applicant if any EHD flies exist. An appointme t for review wail be confirmed approximately ter) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by the EHO staff may not be Immediately ova liable for review. A new application <br /> may be submitted when the file is available. <br /> 4. Any file not returned in the <br /> same Condition at released will be renrgarfzed by EHO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $98.00 deposit prior to review. <br /> F_HD USE ONLY <br /> EMD48-M10,79107 <br /> PUBLIC RECORDS RELEASE APP FORM <br />