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05/26/05 THU 13:40 ,FAX 415 9475 PES ENVIRONMENTAL lib 0' <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTpI,HEALTH DEPARTMENT / D � <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 `/+� <br /> 2005 MAY 26 PM� one:(209)468-3420 Fax:(209)464-0138 Web:www.Sjgov.orglehd <br /> �4 <br /> S A N' J 0 A 0 U IN G o u n PUBLIC RECORDS RELEASE APPLICATION <br /> EF'uS �V1Y LYS1�Y � <br /> H p BUSINESSIAGENCY: <br /> APPLICANT: 3k- IDO lV <br /> ADDRESS: 0� <br /> Qqp FACSIMILE: ql5' <br /> PHONE(1): 11(5 CJ 1 1 -jLp()Q PHONE(2): <br /> Time:�� <br /> TENTATIVE"APPOINTMENT DATE:� broil 7e ve only-must be tonnrmed) <br /> (Please allow 10 business days fro�wayN/){{(/y �yT—y}sIFs1�/�� <br /> ❑ CHECK BOX TO EXPEDITE REQ EST•593.6Citt f� H Vrt`'^GCI R OUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE SIS <br /> SIGNATURE OF APPLICANT <br /> UNIT DISTRIBUTION ❑Unit 1 ❑Unit 2 ElUnit3 ❑Unit 4 ❑Unit 5 [3 Unit 10 other(elecuonicalstahnaps) <br /> FILE ADDRESS EHD USE ONLY <br /> stets sae.tNam city T <br /> 2. Q µ <br /> 3. <br /> 4. <br /> S. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> Sp70. <br /> to Date Range of Information Requested:from o <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑HOUSING ABATEMENT r3 WASTE FACILITYNEMICIE <br /> NOERGROUND TANK(US')CLEANUP SITE(LOP) ❑FooO FACn.rIY Cl WASTE TRE <br /> V_OTHER CLEANUP SITE(NON-LOP) • ❑DOG KENNEL ❑DAIRY <br /> NOERGROUND TANK(MONIIORING1REMOVAL) Cl CHICKEN RANCH [3 WASTEWATER TREATMENT PLANT <br /> B WASTE GENERATOR y0MOTELMOTEL C]PUMPERTRUCK/YAROICHEMTOILEIS <br /> IERED PERNITTEO FACILITY ❑POOUSPA O LAND USE APPLICATION SITES <br /> O TATTOOIBODY PIERCING ❑OTHER(PLEASE SPECIFY) <br /> ❑MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMn RECORDS ARE AVAILABLE FOR REVIEW - MONDAY•FRIDAY 8:00 AM-6:00PM EXCLUDING OLIDAY& <br /> e s of files from the list above by checking the <br /> 1. List up to ten addresses In the space above. ) <br /> ve. Select the type( <br /> appropriate box(es). At least one file type MUST be selected.dFaxditioonall to a 464-0138 ssistance witt mail to the address <br /> Indicated above- Address ranges will not be accepted-for aah 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 fife 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 /> at the 4. Any file not returned In the same condition as d ill be reorganized by <br /> staffrior o reviewPense of the <br /> applicant Future file reviews by the same applicant Y 4ei e a$93.00 deposit <br /> EHD W2D <br /> WINDS <br />