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05/13/2009 09:54 FAX . x001/001 <br /> RMF��E(V D EHD LOG NUMBER <br /> pl �(VVJJ�II'�U\\v'JIIL��- SAN .IOAQUINCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT �� <br /> 0 East <br /> MAY 1 3 n, CA 95202-3029 <br /> I HE Telephone: (209) 468-3420 Fain ax: (209)46401 8 Web: www sgov.org/ hdS 0 02 <br /> ENViRONMEN T HEALTH <br /> PP, PUBLIC RECORDS RELEASE APPLICATIO <br /> Epfa>vSEe <br /> APPLICANT: BUSINESSIAGENCY: C-n cffi an SE Iee <br /> ADDRESS: 3434 MfrlrLon) /3v'4 Ore G / �/ <br /> PHONE(1): 06 496 0241 PHONE(2): FACSIMILE: Q16 4160 0&03 <br /> TENTATIVE"APPOINTMENT DATE: SI�"I�OQ+ Time; U'�18r1 _�nQ <br /> (Please allow ton businass days from dal^Of application submittal.•Teefarive only-must ba con11r j d) <br /> ❑ CHECK BOX TO EXPEDITE REOU ST-$98. EE(CA OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPL ICAh V (� 1 U DATE _ V)1/0% <br /> Electronic Information: ❑ List El Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stmtt 8 Street Name city E3 Unit 1 <br /> 1. 7or6 or+� v�'-- 0L)"W S1 c ckton it1 — <br /> 2• 3M5 wzq gofK S}f'[ei L61,Ckot A4F47 CIUnit2 <br /> 3. 404 N'fma>1r f"'10 r <br /> 4. HLLA V&r $Elfev-L rWe+ 5k.olc df' 3sa�, 90115 Units <br /> S. tia5 r4syY 9o2reTdl ;��Lcten ti. F <br /> 6. 405 G)1�B In S �_ /1/. F.- ` nit4 <br /> 7. 611 w r"MoAi 1+i60 A/I F F <br /> 8. O Unit 5 <br /> 9. <br /> /Il <br /> 10. nit s <br /> Specific Date Range of Information Requested:From 44 '0 ECrf 1105-}" to 200$ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M DNDEROROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUNT40 ABATEMENTSII SOLID WASTE FACILo YIVEHICLE <br /> CXOTHER CLEANUP SITE(NON-LOP) ❑FOOD PACILITY j�WASTE TIRE <br /> MEUNDEROROUND TANK(MONITORINOIREMOVAL) 13 DOG KENNEL ❑DAIRY <br /> 15t HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> CE TIERED PERMITTED FACILITY Cl MOTEJHOTEL ❑PUMPER TROCKIYARDICHEM TOILETS <br /> TATTOOIBODY PIERCING O POOLISPA O LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPRCIIY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FMDAT 8:00 AM-O:OOPM - EXCLUDING HOLIDAYS. <br /> L List up to ten addresses In the space above. Select the type($)of flies from the list above by checking the appropriate <br /> box(es), At least one file type MUST be selected. Fax to(2Q9)464-0136 or mail tot the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant N any EHD flies exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application. The flies 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 the EHD staff may not be Immediately available for review. A new application <br /> may be submitted when the file Is available. <br /> 4. Any file not returned In the same wndition 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD a-06 1012MT PUBLIC RECORDS RELEASE APP FORM <br />