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Apr, 13. 2005 9;21RM A' CED GEO o, <br />DATE �CIYCl/ <br />SAN JOAQUIN COUNTY <br />�i ((„E VJJ ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />APR 1 3 2005 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgo' .org/ehd <br />EP�V,r O1Mf'-NT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />"�v v <br />01 21 EHDP' 1NUMBER <br />PHONE (1)' IN s� PHONE (2): � FACSIMILE: <br />TENTATIVE” APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - "Tentative only - must be confirmed) <br />0115'HECK BOX TO EXPEDITE <br />SIGNATURE OF APPLICANT <br />UNIT DISTRIBUTION 1 ❑ Unit 1 <br />OR CHECK ONLY) -REQUEST PROCESSED IN 3 B SINES DAYS.( <br />DATE 7r <br />4 0 Unit 5 O Unit 6 a <br />Will =97 <br />ilTiTi <br />0� �MJI llT n �iiT-�77 <br />�IAInIM'Fto FIAQEN'4�­ <br />Specific Date Range of Information Requested: From J, <br />'JI�L��IIL�I��� <br />g <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING{ ABATEMENT <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACIuTY <br />UNDERGROUND TANK (MONITORINWREMOVAL) <br />❑ DOG KENNEL <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ TIERED PERMITTED FACILITY <br />O MOTELIHOTEL <br />❑ TATTOOIBODY PIERCING <br />❑ POOLISPA <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPEC <br />r-1 <br />❑ SOUD WASTE FACILITYNEHICLE <br />O WASTE TIRE <br />❑ DAIRY <br />OC- (1ASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCKIYAROICHEM TOILETS <br />LAND USE APPLICATION SITES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:001`II - 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 mail 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 />FIND NNO <br />EHD 48.02.006 tM 4"J - #4 <br />W4105 <br />