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DATEAP r,11 2005 9: 21AM ODYANCED CEO N0. 0 12 1 EHDP• 1NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor, Stockton, CA 95202-2708 1 "70Y3t�Ni <br /> I 70(15 Telephone: (209)468.3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIr ONft-TENT i-IEALTN PUBLIC RECORDS RELEASE APPLICATION <br /> Fl.r, vl r.l <br /> APPLICANT: BUSINESSIAGENCY: trQl1�1LI L7OL'�/7(/II' / <br /> ADDRESS: 3 <br /> PHONE(1): 7,M 07_-IX (( PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Plane allow 10 business days from date of application submittal-'Tentative only-must be confined) <br /> YYCHECK BOX TO EXPEDITE REQUE 3. DR CHECK ONLY)-REQUEST PROCESSED IN S B SINES DAYS A <br /> SIGNATURE OF APPLICANT DATE 4b Z <br /> UNIT DISTRIBUTION ❑ Unitt nit2 ni it4 Units o Unita ❑ Other(oloctronldllstslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name City <br /> 1. <br /> no LUeS <br /> 3. <br /> A. U Vl0,-)AA <br /> 5. <br /> 6. C dD 450 <br /> 7. T 11 CONVM.ME <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From fIZC/ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �tUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 13 80UD WASTE FACIUTYNEHICLE <br /> �a.1(OTHER CLEANUP SITE(NON-LOP) IZIFooDFACILITY 0WASTETIRE <br /> �+UNDERGROUND TANK(MONFFORINGIREMOVAL) ❑DOG KENNEL O DAIRY <br /> VNLHAZARDOUSWASTE GENERATOR ❑CHICKEN RANCH 00WASTEWATER TREATMENT PLANT <br /> 171 TIERED PERMITTED FACILITY OMOTEIJHOTEL 0 PUMPER TRUCKMARDICHEM TOILETS <br /> d TATTOWBODY PIERCING ❑POOLISPA or LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AMS:DOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of riles from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0136 or mail to the address <br /> indicated above, Address ranges wilt 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 /> END U& 2a Ir <br /> 111"5 <br />