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EI ED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> IIJI \VU <br /> APR 2 1 210 ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR <br /> 600 East Main St. Stoddon, CA 95202-3029 <br /> ENV{ROMENT 4 Ine: (209) 466-3420 Fax: (209) 464.0138 Web: www.$)gov.or /7 <br /> FERMM'SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY; SbG. <br /> ADDRESS: 50:[,0 tJ. S,XT-4 ' T- Sw7f_iSZ. CITYISTATE2IP: 0f--,z4R5'-/0 <br /> PHONE(1): 6n- ,ZZ-1, NS/ PHONE(2): FACSIMILE: 221�✓rZ <br /> TENTATIVE`APPOINTMENT DATE: At, SP,,iASP ale f�d4� Time: <br /> (Please allow 10 business days from date of appllcatlon aubmittel-"Tentetive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$715 FEE(CAS R r ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ee,4a DATE `./"�/'✓✓p <br /> Electronic Information: ❑List❑ Map-Descripti <br /> FILE ADDRESS EHD USE ONLY <br /> Street it Street Name City Unit 1 <br /> No C0451 ... .-....-- <br /> 2. CpN✓rW SM6 MrA4 If�A>ur'i/ Unit2 <br /> 4. I q IGJ _ nit 3 <br /> s. OI1.YI it 3(!J� <br /> T. <br /> 0. Lj Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From JAy p} to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES J 1Ytv1 <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATENIOn' ❑SOLID WASTE FAQLITYNEHICLE <br /> ❑OTHER CLEANUP SHE(No*LOP) Q FODD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVALJr,�,,y.( ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATDR—L ❑CHICKEN RANCH []WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITV,< ❑MOTELIHOTEL ❑PDMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SGPTic PERMIT RECORDS ARE AVAILABLE Fo0.REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to Den addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091484-0138 or mall to the address Indleatod aboya._ Address <br /> ranges will not be accepted-for add itlonai assistance with file addresses,contact the EHD. Applications recelvad atter <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will nufffy the applicant Ifany EHD files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 EHD staff may not be Immediately available for review. A now application may he <br /> submitted when the file Is available. <br /> 4. Any file not returned In the some condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diana Martinez,at(200)488-3425. <br /> CH n us ONLY <br /> i / J <br /> EHD t&Da 02TMS <br /> I 'd 2SbT-622-655- t SZueZTnsuoC eZTaD eu,falS eEb II 0I 12 JclU <br />