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I <br /> DATE RECEIVED e <br /> SAN EHD LOG NUMBER <br /> JOAQUIN COUNTY <br /> ENVIRONMENTAL HEAL DEPARTMENT <br /> 304 East Weber Avenue; 3rd Floor S ockt <br /> on, CA 95202-2708 <br /> 1 Telephone; (209)468-3420 Fax: (209)464-)138 Web: www.sjgov.org(chd083 <br /> PUQQBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: vL eL -1 SUSINESSIAGENGY: ? ? <br /> ADDRESS: � (A �l � �=l�C_� <br /> � C <br /> PHONE(1): — U PHONE(2): <br /> . FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: rime: <br /> (Please allow 10 business days fir too ap kation subittal-'Tentative only-Must be confirmed) <br /> CHECK BOX TO ECPEDITE REQ F <br /> (C ........ <br /> rz- NLY -REQUEST PROCESSED(Ei 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Q <br /> Electronic Information: 0 List 0 Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> *Street# Street Name C11 Y <br /> 1• J G ❑ Unit 1 <br /> 2. - <br /> 3. © Unit29 <br /> 4. <br /> 5. unit 3 <br /> 6. - u14 <br /> �Unit4 <br /> 7' <br /> 10. .❑ Unit s <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILM . <br /> 1ND8RGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILAT VEHICLE <br /> �G0 OTHER CLEANUP.SITE(NbN-LOP) 0 FOOD FACALITY 0 WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOYAL) E3 DOG KENNEL 0 DAIRY <br /> 0.HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH WASTEWATER TREATMENT <br /> O TIERED PERMrrrED PACK= 0 MOTELIHOTEL 0 WAS ER ATER T YA TREATMENT <br /> PLANT'TOILETS <br /> 0 TATTOOIBORY PIERCING 0 POOLISPA 0 LANK USTRucK ICAr1UN mEm <br /> MEDICAL WASTE FACILITY ES <br /> 0 OTHER,(PLEASE SPEC) ) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REYIEw - 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 file from the list above b checkingthe a <br /> opriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-01:18 or mail to the address indicatd above indicatedAddress <br /> ranges will not be accepted–for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:08 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximu of rive 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 now application may be <br /> submitted when the file is available. <br /> r <br /> 4. Any file not returned in the same condition as released will be reorga ized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review., <br /> EHD USE ONLY <br />