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rENVIRONMENT <br /> tHULVIiNUMbt <br /> `�(](� SAN JOAQUIN COUNTYCO \Y/ LSD ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, it on,b: WW-Sj9 v.or AR N�'— 2005 Telephone: (209)468-3420 Fax (209)464-013 Web: wwwsjgov.org/ehd sly HEALTH PUBJLIC RECORDS RELEASE APPLICATION <br /> T: ' BUSINESSIAGFNCY:DRESS:ONE(1)A.rj 0 7'6z6iftre" —_PHONE y`n�ldr_ FACSIMILF4Li ? -��/..�,51 <br /> TENTATIVE'APPOINTMENT DATE: �y`/f� 'r - gaac Tima: /.O tq/N <br /> (Please allow 10 business days from date of application subnittat-"Tenfative only-must be confirmed) <br /> 173 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(,CLASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> �� <br /> SIGNATURE OF APPLICANT /J r, ol `.r -DATE ,?y 9'a J <br /> UNIT OISTR18UTION ❑ Unit 1 ❑ Unit 2 Cl Unit 3ntt 4 d Unit 5 ❑ Unit 6 ❑ Other(electron'C4isWm ps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. <br /> 3. 00 <br /> 4. <br /> ! r. <br /> s. Tai .fie r',�. <br /> Zl tj F rfvtv� r7 - -- <br /> 9. /�f�/%J �fO f vc <br /> 70: rl; F,F <br /> �y <br /> Specific Date Range of Information Requested;From 1 �l�. to N�3ilfe 47- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 1]SOLID WASTE FACILITYNEHICLE <br /> (3 OTHER CLEANUP SITE(NON-LOP) ❑FOoo FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD)CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY J'OTHER(PLEASE SPECIFY)J� <br /> WELL.AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-9:00pM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with rile addresses,contact <br /> the EHD.Applications received after 3:00 pre 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 <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 be 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 /> EHO 4642.006 <br /> 11@]100 <br />