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05/01/2012 11: 32 41598:%4.�1 NINYO MODRE <br /> � PAGE 01 <br /> [)A T E REOEIVED EHn LUQ NUMBER <br /> SAN JOAQUIN COUNTY <br /> n� I--N E�.J ENVIRONMENTAL HEALTH DEPARTMENT <br /> �l 600 East Main St. Stacidon, CA 95292- 029 <br /> Zh,?Tcdep6'ac�ne-; (209)465-3420 Fax: (299)46-4-0135Web.WWVj._SjgQv,orglehd <br /> EV a NTAL HE <br /> LX 0 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t i � G' j � BUSINESSIAGENCY: <br /> ADDRESS: Int 6 W 1_165 1 X45_ CITY/STATEIZIP: WOZ,-�,J <br /> r <br /> PHCRJE (i):r`(0 G 3� 6q" PHONE (2): 9_/0 '�lc, FACSIMILE: -9to 6 ,- <br /> TENTATIVE4 APPOINTMENT DATE- Aie - Time; 130 /1% <br /> (Pleaso allow 10 business(lays from date of pplication submi#aI-4renfat/ve only•must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE Ri-;QUEST-$125 FEE(CASH OR CHOCK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTO!Eee DATE <br /> Electronic Information: ❑ List[] Map—Description: <br /> FILE ADDRI=SDS END USE ONLY <br /> Stre9t Street Name City _ ❑ Unit 1 <br /> ZS <br /> t` (( '1JIC <br /> 1' �r — ;M Unit <br /> 3. <br /> 4. ?(c.7 f`rl"_C. 1–il (!'(�C �0unit3 7 <br /> r`,/.11U d/ �, .7 1 ', f <br /> 1 t2 t 3 [71Unit4 0_jkN <br /> `-- Please respond as soon as possible. 5/11112 <br /> I need to notify applicant during week of 5/14/12 if unit s <br /> EHD has files for listed addresses or not. <br /> Z Unit B <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HSALTH DEPARTMENT FILES <br /> ®UNDr;RrROuND TANK(UST)CLEANUP SITE(LOP) HoUrma ABATEMENT JE SOLID WASTE FACILITYIVtNICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ®FOOD FACILITY WASTE TIRE <br /> UND5RGROUND TANK(MbNIYoRINWREMOVAL) ®DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED FERMITTFD FACILITY ®MOTEL(NOTEL PUMPER TRUCKtYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POCLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMi T RECORDS ARE AvAILABLE FOR REVIEw: MONDAY-FRIDAY 5:00 AM-S:OOi,at(EXCLUDING)-OLIDAYS) <br /> 1. t_Ist go to ten_adcjmsas in the space above. Select the type(s)of files frorn the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. r-ax to(909)464 0135 nr mail to the addrass indleiatad above Address <br /> ranges will not be accepted-for additional assistance with file addrAsses,contact the EHLI. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The FHD will notify the applicant If any END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five businees days for review, Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by F.HD staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not retumed in the same condition as relleaged will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review, <br /> 1'C=10 <br /> EkID 4B-P5 ••• - — - flIi(99 �' <br />