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05/26/05 THU 13:40 FAX 415 _ D? 9475 PES ENVIRONMENTAL U0 <br /> (^ EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> 2 <br /> 0 <br /> 05 SAY 26 (209)464-0138 <br /> PM FV41one:(209)468-3420 Fax:(209)464-0138 Web:www-Sj90v-0f9/ehd <br /> SAN to A 0 UIN c puN T$UBLIC RECORDS RELEASE APPLICATION <br /> E PES 1:Y1V tY(yJl � <br /> {� BUSINESSIAGENCY: <br /> APPLICANT; O J TDO uvocltp <br /> ADDRESS: ),f� aqp, nom, <br /> PHONE(1): "r(5�CJ 1 I �&r)O PHONE(2): FACSIMILE: 4I5' <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 buslneas days froff!R <br /> bmk reA{ Ve only-mustbeconfimed)❑ CHECK BOX TO EXPEDITE REQ EST•593. CK Rff QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE S5_ f OJT <br /> UNIT DISTRIBUTWN 0 unit 1 ❑Unk 2 O Unk 3 0 Unk 4 O Unit 5 O Unk S 0 Other(electronicAlstshnaps) <br /> FILE ADDRESS EHD USE ONLY b <br /> Street i Street Name City <br /> 2. u <br /> 3. 5 <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 6. r <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From <br /> to <br /> t ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑HOUSING ABATEMENT CT SOLID WASTE FACILITYNEMCLE <br /> NDERGROUNDTANK(UST)CLEANUP BITE(LOP) FOOD FACILITY ❑WASTE TRE <br /> THER CLEANUP SITE(NONIOP) ❑FOODOG KENNEL 0 DAIRY <br /> NOERGROUND TANK(MOWMWIWMOVAL) ❑CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTE GENERATOR } ❑CHICKEN TEL H O PUMPER TRUCK(YARD/CHEM TOILETS <br /> IERED PERMITTED FACILRY 0POTELMO 0 LAND USE APPLICATION SITES <br /> 0 TATTOOIBODY PIERCING ❑OTHER(PLEASE SPECIFY) <br /> OLJSPA <br /> 0 MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW- MONDAY-FRIDAY 8:00 AM-B:UDPM • EXCLUDING 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 <br /> appropriate box(es). Atli stone flie type MUST be selected. Fax to 12091464-0138 or mail to the address <br /> indicat_ed above• Address ranges wIII not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Appllcations received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be 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 <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> u <br /> EHO 4Fa2-0C9 <br /> +n Woe <br />