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DATE RECENED EHD LOG NUMBER Jo.�Qvnv COUNTY <br /> • ' ENVTRoNMENTAL HEALTH DEIPARTMNT <br /> 304 East Weber A,ve=,P Floor,StocktoN CA,95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.arg/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: YTD 14/bUrl'V� _ BUSMESSIAGENCY: AaZ Cov�4'1.7AW7S <br /> ADDRESS: �S Grlaar�ir4 �[.g�tf.0 X57 d-� 4jsr��vUt GA.._ Cd- Oq PHONE(l): �� &3'- lofA.'� PHONE(Z): FACSIMILE: <br /> TENTATIVE*APPOINTIYIETIT DATE:_. Time: <br /> (Plewa allow 10 buslru=days from date of appiicadan submittal-•FentWve only-must be confirmed) <br /> 13 CHECK sox TU EXPEDrrE REQ EE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAY'S <br /> SIGNATURE OF APPLICANT DATE °�/°1�I 6 <br /> UNrr DISTRW;;;N a Unit 1 O Urtlt 2 O unit O Unit 4 12 Unit 6 ❑ Unit B C Qfhsr(eiQceronlellists! s) <br /> FILE ADDRESS EHD USE ONLY <br /> StMGt 9 street Name CRY <br /> 1. ' ! etv)I r' Ne- <br /> 2. .935' c*f* +a <br /> 3. 00 fi, <br /> 4'. <br /> 7POW ' <br /> 8. � <br /> 9. <br /> a <br /> Specific Date Range of Information Requested:From t900 <br /> ENVIRONMENTAL HEALTFI DEPARTMENT FILES <br /> krUNDEfi6RMMD TANK(UST)CLVWUP WE(LOP) ❑HOUSING ARATEIMM 191`80LiD WASTE FACUTYMEMCLE <br /> CLEANUP Srn;(NON-LOP) 13 Fow FACUTY W WASTE_Tfm <br /> UNDERGROUND TANK(MorareR1NWt movAL) 0 Doo KENNEL Iff Damn <br /> i HAZARROUS WASTE GENERATOR O CNKxEN RANCH WWAgMWATER TREATMENT PLANS`. <br /> r7 TEERED PERinrrr¢p FACtLnT O M018LlHOM 0PWd?MTRUCKIYARDICKRM TOILETS <br /> 13 TAT7oo10=PieftiNc C7 POOLIBPA 19 LAND USE ADPL v-ATECN Saes <br /> E3 MEMAL WASTE FACILITY OWER(PLEASE SPECIFY) <br /> WELL AND SEFM PETtmrr Recofm ARP AyAILABI.E-Fos RMew- MCNDAYfWOUIY&40 Am-CW m - EXLY.Wmo Hcruo me. <br /> i. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> approprieW box(es). At least one file type MUST be selected. Fax to(208.194-0138 ar mail to the addms <br /> 'ndlcatad aLAM. Address ranges will not be accepted—for addltional assistance with File addresses,contact <br /> thle EHD.Applications received after 3:00 farm 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 fila$will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 4. A file that Is actively being worked on by Elie 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 some condition as released will be reorganized by EHD staff at the expense of the <br /> applicant Future fie reviews by the same applicant may require a$93.00 deposit prior to review. <br /> t:HD 4s.ot-cos <br /> 1M�Ia5 <br />