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UM It Kr-UhIVEU t_"u LUUIqumutK <br /> SAN JOAQUIN COUNTY <br /> '9 <br /> ENILONMIENTAL HEALTH DEP'ARTNWT k <br /> 304 t Weber Merkur, 3 on,CA.95202-2708 � <br /> .Telephone: (209)468.3420 Fax (209)464-013 Web:www.sjgov.org/ehd <br /> JAs ��06 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 4 fGUSINESSIAGENCY• !? <br /> AD REBS- <br /> PHONE(1): PHONE(2), ^FAG5MILE: r <br /> 4 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please.allow 10 business days from date of a I plication subn -"Tentative only-must be avnflrmedf <br /> CHECK BOX TO� REQ.EXPEDITE RET 40 FEE JCASH OPCHECK ONLY)-REQUEST PWCFSSED'iN 3 BUSINESS DAYS <br /> SIGNATURE OF ADPL=ICANT :DATE +-' •� <br /> UNIT IIISTRi9UtION i O Unit 1 ❑Unit 2 Q Unit 3 0 Unit,4 tO Unit 6 d Unit 8 O ether(e1ect+onlc11 sWmaps) i <br /> FILE ADDRESS EHD USE ONLY <br /> Street!! Street Name City <br /> 2. _ 5 <br /> y 10A <br /> 4. r. , <br /> Specific Date Range of information Requested:From .. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> W-UNDERGROUNO TANK(LIST)cLEANup SITE(LOP) 17 Hoe siw AsATFmENT 0 Soup WASTE FAOIuTY/VEH1cL.E <br /> OTHER CL EANIIP$ITE(NON-LOP) 0 FOOL)FAciuTY 13 WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) 11 DOG KENNEL ❑DAIRY 1 <br /> L1 nAZARDOU$WASTE GEHEKATOR 0 CHr.KEN RmcH 0 WASTEWAT>-R TmATMENT PLANT <br /> R TIEREb PERMITTED FACILITY O iHOTELMOTEL M PMPER TRUCKlYARWCHEM TOILETS <br /> ©TATTOOlBopY PjERcING 0 POOUSPA 0 Lao USE APpuC TION SITES <br /> 13 MEDICAL WASTE FAClu-cy . 0 OTHER(PLEASE SP _ <br /> WELL,AND SEPTIC PERMIT RECORDS ARR AVAILABLE FOR REVIEW - MONDAY4F Y 8'00 AM-6:OOPM - EKCLUDING Hol DAYS, r - - <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 209 454-0138 or mail to the address 1 <br /> in above. Address ranges will not be acceptedµfor 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 /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHO 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 saute 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 /> tj <br /> EHD 48-0j. <br /> 11125IOq ' <br />