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06/10/2029 11:29 0000000000 PAGE 01/01 <br /> rrlU LW"NUIVIOMN <br /> D. E �CENED SAN JOAQUIN COUNTY <br /> G� nn V1 D <br /> . r 14�I I[J ENVIRONMENTAL�IEALTH DEPARTMENT <br /> JUN 1 Q 2009 304 Fast'�Veber Avenue, 3`d ton' CA 95202-270 <br /> Telephone: (2119)468-3420 Fax 464-013 Web:www.sjgov.oid OFO <br /> EPViK J E i VCH <br /> FERMIUSER1iHS PUSLI "" RE CORDS RELEASE APPLICATION <br /> APPLICANT:—0q h -BUSINBSSIAGBNCY: m D jk, <br /> ADDRESS: P <br /> PHONE(1): (2): i4Ra- Sloe —_FACSIMILE: O9 y rol-6111 <br /> TENTATIVE"APPOINTMVIT DATE: +EQPJ(RS"r Time: <br /> (Pioase allow 10 businesip days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REOUII:ST-$93.00 FEE(CASH OR CHECK ONLY)--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � !;� M-(A`lrvvA DATE 6-10.O`Ii <br /> UNIT DISTRIBUTION 0 Unit 1 ,U Unit 2 0 Unit 3 0 Unit 4 ❑ Unit 5 O Unit 6 0 Other(eloctronlcllisWmaps) <br /> FILE AI')DRESS _ EHD USE ONLY <br /> Street# Street Name City <br /> f2 11 11W /A' <br /> 927 -- <br /> 3. <br /> 4. <br /> 6. <br /> 7. <br /> 8. <br /> 10. <br /> Specific Date Range of Information Re;.luested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> fT OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY 0 WASTE TIRE <br /> O LINDERGROUNb TANK(MONITORING/REMOVAI.)X 0 DOG KENNEL it DAIRY f� <br /> ©HAZARDOUS WASTE GENERATOR(( 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITrEb FACILITW <br /> MOTELIHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS 1 <br /> TATTOO/BODY PIERCING;)4 0 POOL/SPAO LAND USE A PUCATION ITES <br /> *MEDICAL WASTE FACILITY( M OTHER(PLEASE SPECIFY)�antt Tn Jane, &R-0 r Mg g'i1 e R <br /> WELL AND SEPTIC PERMIT REcoF;4S ARE AVAILABLE FOR REVIEW - MONOAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the irpace above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least ore file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranclas will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received :after 3:00 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 <br /> approximately ten (10)days aftar 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 worl ed 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 sarr,e condition as released will be reorganized by EHD staff at the expense of the <br /> applicant, Future file reviews b (the same applicant may require a $93.00 deposit prior to review, <br /> h5. �,6 <br /> 6-I b-Qq'- C,►d <br /> Wb <br /> EHD 40.02-000 <br /> 11123104 <br />