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05/03/2005 15:13 FAX 001 <br />EHD LOG NUMBER <br />DATi RECEIVED MSAN JOAQUIN COUNTY <br />R E `C E� U D ENVIRONMENTAL HEALTH DEPARTMENT 17Kolsill <br />304 East Weber Avenue, 3TdFloor, Stockton, CA 95202-2708 <br />MAY 0 ?005Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.Sjgov.org/ehd <br />EMONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATIOQQN'�'' <br />-W1 1 . 1 _ i (n BUSINESSIAGENCY: _SdL <br />APPLICANT: <br />ADDRESS: `o <br />PH,! -NE (1 ): %-��� 23 PHONE (2): <br />FACSIMILE: <br />TENTATIVE' APPOINTMENT DATE: TMe. <br />(Please allow TO business days from date of application submittal •'Tentative only • must be confirmed) <br />0 CHECK BOX TO EXPEDITE RE <br />SIGNATURE OF APPLICANT C <br />EUNITDISTRIBUTION ❑Unitl <br />ti Street fl <br />F�+IUSs 1 <br />5. <br />$93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE -05 <br />❑ Unit 2 ❑ Una 3 ❑ Unit 4 ❑ Unit 5 0 Unit 6 ❑ other (electroniGlistslull <br />Street Name <br />USE ONLY <br />Specific Date Range of Information Requested: From P1fy'v r0 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES, f <br />GI �JNDERGROUND TANK 01ST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 13 SOLID WASTE FACIDNNEHICLE (�I%� <br />El THER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY ❑ WASTE TIRE <br />IS UNDERGROUND TANK (MONITORINGIREMOVAL) ❑DOG KENNEL ❑ AMITY <br />0 H AZARDOUS WASTE GENERATOR 13 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑MOTELIHOTEL 13 PUMPER TRUCKNARDICHEMTOILITS <br />❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY 13 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW - MONDAY -FRIDAY 8:00 AM-S:OOPM • 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). At least one file type MUST be selected. Fax to (209) 464-0138 or mall to the address <br />indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD. Applications 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. A new <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 />