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w • r r.�4F1tLL � � - - _ . <br /> (� <br /> p��] SAN JOAQUIN COUNTY � CHLA LOU I4VMtlk <br /> m EC O V E D ENvuzONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 37ton, CA 95202-2708 <br /> MAR S— 7005 Telep6.one: (209)468-3420 Fax (209)464-013 Web: www.sigov.org/chd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS REEEASE APPLICATJON <br /> APPLICANT: <br /> 13USINESSIAGENCY: <br /> ADDRESS: ( (I <br /> PHONE(1). r PHONE(2). I <br /> TENTATIVE*APPOINTMENT DATE: .- <br /> FACSIMILE <br /> (Please allow 10 business da >aP ~ Time:,&2 a&3 <br /> days from date of a licatiall submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(GASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> UNIT DISTRIBUTION O Unit 1 ❑ Unit 2 ❑ Unit 3 nit 4 C7 Unit s Q Unit 6 ❑ other(electroniCllistafmaps) <br /> FIZE ADDRESS <br /> Street# i� Street Name city EHD USE ONLY <br /> 2. <br /> - <br /> 4. <br /> s: Z7. <br /> � "� I <br /> F 1 1`yj <br /> 9. <br /> Specific Data Range of Information Requested:From,�f�f `. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ADATEMENT ❑SOOP WASTE FACILITYIVWICLE <br /> OTMER CLEANUP SITE(NoN-ROP) 0 FOOD FACILITY CJ WASTE TIRE <br /> UNDERGROUND TANK(MpNffoRINOtpF OVAL) D DOG KENNEL i7 DAIRY <br /> O HAZARDOUS WASTE GENERATOR ©CHICKEN RANCH E3 WASTEWATER TREATAAENT PLANT <br /> TIERED PERmiTT'ED FACILITY s MOTEL/HOTEL ❑PUMPER TRUCK/YAIZDICHEAA TOII.ET3 <br /> Cl Cl T E131CA WASSooy PIERCING �' ❑POOL/SPA ❑LAND UsE APPLICATION SITES <br /> MEDICAL WASTr FACILITY .<OTHER(PLEA$$SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILASLE FOR REVIEW- MONDAY-1791DAY 8:00 AAA-5:00P-M - 6, _LUDING HouDAY$, <br /> 1. List up to tern addresses Iro,the space above. Select the types}of files from the list above by checking the <br /> appropriate boxes). At least one isle type MUST be selected. Fax to(209)464-M3$ or mail to the address <br /> Indicated above. Addressranges 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 roview 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 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'same condition as released will be reorganized by EHD staff at the expense of the' <br /> applicant. Future file revia" s by the same applicant may require a $93.00 deposit prior to review. <br /> EHh�6-0L006 <br /> s�l�7ro1 Y, <br /> 4 , <br />