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dQTlw REGEl1/EDI:r+v Lug NuNttscrc <br /> ' SAN Jo�.�uzN couNx� <br /> ENWRONmri NTAY.REALTH DuARTM1ErN'� <br /> CD <br /> D 304 East Webcr Avenue,3rd , ton, CA 95202-2708 <br /> FEB � .7 2006 <br /> Telephone, (20 9)468-3420 Fax (209)464-013 Web:www,sjgov.org/ehd 2 j <br /> . { <br /> ENIIIR T NFAI .K - .IC CORDS RELEASE APPLICATION <br /> BUSINU MAGENCY:47,01 <br /> a <br /> ADDRESS' <br /> PHONE(1) PHONE{2): Za /jaC— --,__FACSIMiL.E- <br /> TENTATIVE*APPOINTMENT DATE: ��� A ly - Time: �. <br /> (Please allow 10 business days from date of application submiRtal-'Tentaflva only-must be confirmed) <br /> CHECK BOX T4 EXPEDITE REQUES - 3.00 FEE(WH ORQHECK ONLY)–REQUEST PROCESSED'IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE J--J' � <br /> UNIT DISTRIBUTION i; tJ Unit Z U Unit 2 13Unit 3 ❑Unit 4 ❑ Units 13 Unit 6 U other(eleob=IclnsWm#ps) <br /> FILE ADDRESS END USE ONLY <br /> Street N Street Name City <br /> 2. <br /> 3. <br /> 4. <br /> 6. 2 g) �1 <br /> 10. <br /> Specific Date Range of Information Requested:From __ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDER RWNDTANK(UST)CLEANUP 8rrE(LOP) 4 HOUSINo AamemENT Q SOLID WASTE FAC1LrrYftHICLE <br /> Q OTHER CLEAMP Sft(N6N4_0P) 0 FOOD FACILITY 0 WASTE TRR <br /> ❑t)ND<:RaROUND TANK(Morar,Rff4o/RrmMOVAL) 0 Doc KmNrmL a DAIRY <br /> E3 HAZARDOUS WASTE GENERATOR Q CHICtLI=N RANCH O WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMrrTED FAC16TY O M,oTELIHOTIL, b P'UNFER TRucWYARP10ma!To1LETS <br /> TArrooMoDY PIERCING: 0 POOLISPA ! 13LAN APPL1CgTIoN SITES <br /> ©IYIEDICAL WASTE FACILITY ©OTMER(PLEASE SPECT LJ G <br /> WELL AND SEPTC PERMIT F�CORDS ARE AvAILABLE FOR PZVIEW- MONDAY-FRIDAY 8:00 AY-&:00PM - EXcLuDINA HOLIDnY& <br /> I. List Up10 ten;addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At Ieast one file type MUSS'be selected. Fax to 209 464-0138 or mail to the address <br /> indicated above. 1'Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD].Appllcatons received after 3:00 pm will be processed the next business day. <br /> Z 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 Reid 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 m;lly tie 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 tequire a$93.04 deposit prior to review. <br /> C—Ad 4.14-� AA ce- <br /> ~ <br /> " ' d~ � <br /> 7 <br /> EHD 0102-Dai _ <br /> 'liflS� <br />