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May, 11. 2007 9,37AM Advanced GeoEn6ronmental No. 8568 P. 1 <br /> DATE=RECEIVED %W11 �SAN JOEN€3 LOG NUMBER <br /> COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stock torn, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web. WWW.sjgov.or d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:p [+ rSL� SUSINESSIAGENCY: ti VI n P ( <br /> ADDRESS. O p, J �j Q c po <br /> PHONE(1): 07- y6p / ' 1(0D(p —PHONE(2): <br /> TENTATIVE*APPOINTMENT OATS: Time: .'PU <br /> (Please allow 10 business days from date of a II tion submittal. <br /> *Tentative only-must be confirmed) <br /> CHECK BOX TO EXPE WTE QUEST 495.00 FEE( H OR HECK ONLY)-REQUEST PROCESSED IN 3 BU NE33 DAYS <br /> SIG ATURE OF APPLICANT DATE <br /> J1 17 <br /> Electronic Information: ❑List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City El Unit- � Unit <br /> 2. 30 ❑ Unit2 <br /> 3, <br /> 4. Unit 9 <br /> 6. Unit 4'N <br /> Y <br /> 7. <br /> 6. ❑ Unit 5 <br /> 9. lop <br /> 10. ... - -- ••-- ❑ Unit <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �p UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLC- <br /> OTHER CLEANUP 51TE(NoN-LOP) n PPOD I"ACIL.ITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINafREMOVAL) Cl DOG KENNEL 17 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Cl WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPFA TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO15ODY PIERCING ❑PooL/SPA LAND USE APPLICATION SITE$ <br /> ❑MEDICAL WASTE FAGIUTY q OTHER(PLEASE SPECIFY).. ,. 4 <br /> WELL AND SEPTIC PERMIT RECORD$ARE AVAILAOU FOR RE-VIEW- MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUOING HOLIDAYS. <br /> 1. List up 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)484-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EMD.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 rotumed 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$95.00 deposit prior to review, <br /> EHD USE ONLY <br /> EHD 48-06 0/1312DUO <br />