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DATE RECEIVED EHD LOG NUMBER <br /> SAN <br /> RECEIVED ENVIRO MENTA .LTH DEPARTMENT <br /> 600 East Main St. 'ckton, CA 95202-3029 o <br /> �OtV 2 3 2010 Telephone: (209)466.3420 Fax: (2F9)464.0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> EN <br /> ADDRESS: 23c15 r—, Pe ScaLd" 4y'c , CITY/STATE/ZIP: 7 I41' '1 5_5CJY <br /> PHONE(1): `f iW 2&7- 'i23# PHONE(2): FACSIMILE:_`►`(e)/,ZG 7- �,! 73q& <br /> TENTATIVE"APPOINTMENT DATE: &.T 2, e_c/e Time: <br /> (Please allow 10 business days from data of appllcat on submittal••rantative only•must be Confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE T-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Po DATE 1 r' Z ill d <br /> Electronic Information: [) List[ Map—Description: <br /> FILE ADDRESS EHD U3E ONLY <br /> Street# Street Name city Unit 1 <br /> 2. t <br /> Unit 2 <br /> 3, t�tl0 �1�+bt�-✓r G e1 <br /> 4. <br /> 2e.It <br /> 7. <br /> 8. Ll Unit 5 <br /> 9. <br /> I U. Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACILriYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) I ]FOOD FACILITY IRT WASTE TIRE <br /> UNDERGROUND TANK(MONITORINOIREMOVAL) ©DOG KENNEL. ©DAIRY <br /> HAZARDOUS WASTE GENERATOR Ij CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ©TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> 0 TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC;PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Qg up to ten addresses in the space above. Select the"(a)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0130 or mall to the address Indicated above, Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHO. Applications received after <br /> 3:00 pm will be processed the next buslnasa day. <br /> 21 The EHO will notify the applicant If any EMD 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 EHO staff may not be Immediately available for review. A new application may be <br /> submitted when the file le 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$122 deposit prior to review, <br /> RHD U69 ONLY <br /> EHO 46.06 Wrallb <br /> T/Z'd B0T0b9b602T:01 962E Z92 90bT ?J3W-lUd:WONA Tb:OT OT22-E2-r <br />