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EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIROMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Ave ue, St -6232 CO 1 <br />N <br /> <br />OCT 1 4 2014 Telephone: (209) 468-3420 Fax: 484-0138 Web: www..jgov.org/ehd <br /> <br />ENVIRONMENTAL H EALT -PUBLIC RECORDS EASE APPLICATION <br />DATE RECEIVED <br />RECEIVED <br />APPLIC T: Jct c J<t reut7 n711 <br />ADDRESS: c v\ `VY-51-7..)C,CLI e -r-1 CA-1 CITY/STATE/P: /1/ <br />BUSINESS/AGENCY . <br />PHONE (1): 0 pit) _pp ,,PfrONE (2): FACSIMILE: <br />Please a ow 10 business days from-date of application submittal for the records to be available. <br />Staff wil -contietyp:urtp-arratib-e an appointment date and time to review the requested records. k CHECK BOX TO EXPEIIIZLE REQUEST - SaYEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN -3 BUSINESS DAYS <br />SIGNATURE OF APPLICANii dky fiy /MT r.T. 6[11-1 <br />1 Electronic Information: List Li Map — Description: <br />I <br />FILE ADDRESS El-ID USE ONLY <br />nit 1 Street # Street Name City <br /> .y...? 3 D., E <br />I Fl e- 0 Unit 2 <br /> <br />04)1# <br />10 /14 ilA nit 3 <br /> <br />11 <br /> <br />0 Unit 5 <br /> <br />D Unit 6 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />rAl UNDERGROUND TANK (UST) CLEANUP SITE (LOP) LI MEDICAL WASTE FACILITY <br />OTHER CLEANUP SITE (NON-LOP) <br /> Li HOUSING ABATEMENT <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br /> .1gf FOOD FACILITY <br />ABOVEGROUND TANK <br /> LII CHICKEN RANCH/ DOG KENNEL <br />HAZARDOUS WASTE/HAZARDOUS MATERIALS <br /> Li MOTEL/HOTEL <br />Li TIERED PERMITTED FACILITY <br /> <br />Li POOL/SPA <br />LI TATTOO/BODY PIERCING <br />COMPLAINT/RESPONSE RECORDS <br />Li SOLID WASTE FACILITYNEHICLE <br />Li WASTE TIRE <br />ID DAIRY <br />WASTEWATER TREATMENT PLANT <br />Li PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />Li LAND USE APPLICATION SITES <br />Li OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00PM (EXCLUDING HOLIDAYS) <br />List Lin 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) 464-0133 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />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 />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 $125 deposit prior to review. ***BOXED AREA - END USE ONLY*** <br /> <br />D Records provided by Staff-PPR Complete. Staff Name: <br /> <br />EHD 48-06 <br />4/28/14 <br />