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hep 29 09 02:38p Chandler Legate t1roup <br /> owl 9167012275 <br /> P.1 <br /> 1104 <br /> " ° V ED� SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> SEP 2 9 2009 <br /> ENVIROEast NMENTAL <br /> S. StoccktLTH on, CAD 520-3029 NT <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.o b <br /> ENpVIRUNWNT HEALTH ` <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> ADDRESS: BUSINESS/AGENCY: <br /> t 1. S <br /> CITY/STATE/ZIP;, OrS far/ <br /> PHONE(1): - t - ..INE(2):_q I� 7 <br /> TENTATIVE'A POINTMENTDATE: FACSIMILE: - <br /> (Please allow 10 business days from dale Ola Kati�submittal.- Onlyrte' <br /> ❑ CHECK BOX TO EXPEDITE RE EST-$115 FEE CAS rentafive -must be............d _ <br /> ( CHECK Cl <br /> SIGNATURE OF APPLICANT EOUEST PROCESSED IN 3 BUSINESS DAYS <br /> pipiA DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EFW USE ONLY <br /> Street# Street Name City1• O ) Unit <br /> 2. <br /> 3. During <br /> 4. <br /> 5, nI <br /> 6. <br /> 7. Unit 4 <br /> 8. _- <br /> - 8. units <br /> �''e ❑units <br /> Specific Date Range of Information Requested: From UM <br /> . �=/ 29Ta I <br /> ENVIRONMENTAL HEALTH DEPA TMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGASATEMENT ElSOLID WASTE FAGLITY/VEIFCLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TRE <br /> ❑UNDERGROUND TANK(MOMTORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> ❑ LANT <br /> TIERED PERMITTED FACILITY ❑WASTEWATERKNARDIEHT ICAL <br /> ❑MOTE ( ❑PUMPER TRUCYJYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA 1i1�II at4 LAND USEAPPLICATION SITES <br /> ❑ Mf DIDAL WASTE FACILITY OTHER(PLEASE SPECIFY)1Y5t l h G Cye rvyL++ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY S:U0 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List tip to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(2D9)468-3425. <br /> EHO USE ONLY <br /> END4" <br /> OYl7l09 <br />