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t=HL+LLni Nulmcst <br /> - SAN JOA UIN COUNTY <br /> IC."'S1Y/1�JED ENVIRONMENTAL HEALTH.DEPARTMNT <br /> 304 East Weber Avenul3 3`� , C A tan 5 OS <br /> 9 20 2-2 7 <br /> CSAR 7005 Telephone; (209)458-3420 Fax (209)464-013 Web: v",,w.sjgov.org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATJON <br /> APPi ICANT: OUSINESSIAGl NCY:EaL <br /> ADDRESS: 'gyp <br /> PHONE(1):�fj��C�T� ���y�,'� PHONE(2I=�[�����f��l-J <br /> TENTATIVE*APPOINTMENT DATE; rme; f I <br /> (Please all Ow 10 buslness days from date of application submittal-ATi nfaOve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE tCASH OR CHECX ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 0 unit 3 nit 4 ❑Unit 5 ❑ Unit 6 ❑ Othar(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 4. ff <br /> 5, -2S_ � . <br /> 7. <br /> 8. -rzel 11 <br /> J <br /> 10. l�"l3 1 <br /> Specific nate Range of Information Requested:From �r fj _ to <br /> ENVIRONMEN <br /> fAL HEALTH DEPARTMENT F'lLES <br /> L3 UNDERGROUND TANK(UST)CLEANUP'SITE(LOP) 17 HOUSING ABATEMENT C) SOLID WASTE FACILITY/WMICLE <br /> C3 OTHER CLEANUP SITE(NdN-LOP) ❑FOoo FACILITY CJ WASTE TIRE <br /> UNDERGROUND TANK(MQN1TQRIN4WRFM0VAL) El DOG ICENNHL ❑DAIRY <br /> 13 HAZARDOUS WASTE GENERATOk ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY D M91CLI OTEL ❑PUMPER TRuCK1YARDJCHEM T01L m <br /> la TATTO01803Y PIERCING ❑POOLISPA 0 LAND USE APPucATloN SITES <br /> 17 MEDICAL WASTQ FACILITY AOTNE,R(PLEAsp Srrci" 4* 2% 4::! .r7/� <br /> WELL AND SEPTIC PERMIT RE uoRDs AAE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8,00 AIT-5:00pm - EXCLUDING HouaAY& <br /> F <br /> I, 1. List up to ten addresses In the space above. Select the type(s)of files from the fist above by Checking the <br /> appropriate box(es). At least one file type MUSS'be selected, Fax to 209 464-0138 or mail to the address <br /> ed-for additional assistance with file addresses,contact <br /> indicated above Address ranges will not be accept <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 /> f 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 prier to review. <br /> I. <br /> EHb A9-02.006 <br /> 11123194 <br /> i <br /> r <br />