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UA I t Kt(.hIVLL) tr1U LLNS NtJNtk3CK— p� k <br /> SAN JOAQUIN COUNTY <br /> ' EN' ONMENTAL HEALTH DEPA_RT&6 <br /> 4 G � 304 Fast Weber Avenue, 3 oro CA 95202-2708 <br /> Telephone:(209)468-3420 Fax. (209)464-013 Web:www.sigov.org/ehd <br /> 7 PUBLIC RECORIDS RELEASE APPLICATION <br /> ' I BUSiNFSVAGENCY: r 11 <br /> ADDRESS- Cr <br /> PHONE(1). PHONE(2): FACSIMILE: � r <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date*(a plication su 1-*Tentadve only-must be cor finnW <br /> CHECK BOX TO ExpwrrE i7EQU T .00 FEE CASH O HECK ONLY)—REQUEST PROCESSED-IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATEr <br /> UNIT DISTRIBUTION ❑ Unit 1 d Unit 2 ❑ Unit 3 0 Unit 4 ❑Unit s 0 Unit a ❑ Other(electronlelliatslmaps) Ll <br /> FILE ADDRESS <br /> stmet a Street Name City EHD USE ONLY <br /> 2. <br /> 4. <br /> 7. <br /> SpQcfc pate Range of Information Requested: From _ -_ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> kuNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑Hou$ING ABATEMENT Q SOLm WASTE FACIUTYNEHICLE <br /> ©OTHER CLEANUP SITE(Nom-LOP) ❑Foob FA uiy ❑WASTE TIRE <br /> ❑UNDERGROUNO TANK(MONrrommGlREMovAL) ❑DOG KENNEL ❑DAIRY r <br /> 13 HAZARDous WASTE GENERATOR C]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERmTTEp FACIUTY 0 MOTF.0.,fHOTELE3PUMPER TRUDWARDlCHEM TOILE <br /> D TATTOOJBopy PIERCING ❑POOLtSPA 101 1p Tio <br /> o Use AppFuS N SITES <br /> ©MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPEC" } <br /> Wsu,AND SEPTIC PERmff Recoms ARR AVAn ABLE FOR REVIEW - MONDAY-FRIDAY 11:00 AIW-6:4Qpal - 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 209 454-0133 or mail to the address <br /> indicated eboye. Address ranges 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 after receipt of application. The files will be held for a Maximum of five business. <br /> daya 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 sante 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 /> `" -- <br /> EI1a asaxaoa <br /> 11R�f64 ' <br /> o <br /> J <br />