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DATE fiECE11►Ef3 - L'E'7V LVID�iVIVtt3CK <br /> SAN 3oA,QurN COUNTY <br /> REG <br /> RNWRONM�NTAL REALTH]PPA.RTMENT'V D 3 b4 Eas#Weber Avenue,3'� ton, CA 95202-2708 <br /> • www.�jgov.org/ehd <br /> Telephone. (249)46$-3 2a Fax {2a9)464-ot3 Web:www.s�go g/�'�8 � .7 2006 Z073 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> OUSINESSIAGENCY:�— — <br /> ADDRESS: } <br /> PHONE(2). , '' ,_FACSIMILE: Ir <br /> TENTATIVE*APPOINWENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Terrfaflve only-must be confirmed) } <br /> ❑ CHECK BOX TO F_CPEDITE REOUES - 3.00 FEE(CPH OR ECK ONLY)—REQUEST PROCESSED'IN 3 BUSINESS DAYS f <br /> SIGNATURE OF APPLICANT DATE +" "' <br /> UNIT DISTRIBUTION to Unit 1 C1 Untt 2 q Unit 3 ❑Unit 4 D unit 5 O unit S 0 Other(electroa[cAlsts►maps) 1 <br /> FILE ADDRESS EHD USE ONLY <br /> 5trset* Street Name city ; <br /> 1. <br /> 2. <br /> 3. 1 011 <br /> ' 9! <br /> S. - <br /> 9. ; <br /> Specific Date Range of information Requested:;;roar to p't <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 13 UNMRGIROUNDTANK(UST)CLEANUP Srrg(LOP) C!HOUSINGAvATr:mear 17 SWD WASTE FACILITYMEHiGLE <br /> Ia OTHER CLEANUP SITE(NoK4_0P) Q FOOD FACIuTY 0 WASTE T= <br /> ❑UNDERGROUND TANK(MONn1ORINpftHOVAL) D Dw KENNm. O DAIRY <br /> E3 HAZARDOUS WASTE GENERATOR IO CHXKPN RANCH CI WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMftTsn FACILITY ❑MOT 'MOTEL 0 PumPER TRucK/YAR@lOmm TOILETS � <br /> 1 G TATTOOBODY PIERCING D POOLISPA f ❑LAND APPLICATION$TE$ <br /> o MEDICA4 WASTE FACILITY D OTHER(PLEASE SPECIFY I <br /> WELL AND SEPTIC PERVAIT RECOIW9 ARE AVAILABLE AOR REVIEW- UoNOAY-FRIDAY 8:00 Am-6:00PWf - EXCLUDING HOUD'AYS. <br /> 1. List up to ten addteisses in the space above. Select the type(s)of biles 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 file addresses,contact <br /> the EHII.Applications received after 3:00 pin 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 confinbed <br /> aPProximately ton (10)clays after receipt of application. The files will be held for a maximum of five business. <br /> 1 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 retumed 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 /> 7 A <br /> erro 0.42.ea <br /> ,vz3Aoa . <br />