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Apr. 13. 2005 9:21AM DANCED GEO No. 0121EHDP' 1NUMBER <br /> DATE <br /> SAN JOAQUIN COUNTY " <br /> D ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3'd Floor,Stockton,CA 95202-2708 <br /> APR 1 3 2005 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgo�.org/ehd <br /> ENVIE 0Nt,1ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ti BUSINESSIAGENCY: <br /> ADDRESS: 9L7 gbftZAr;sL0 <br /> PHONE(1)' PHONE(2): " FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Y`1 Time: <br /> (Please allow 10 business days from date of application submittal-*Tenfatfve only-must be confirmed) Gi <br /> HECK BOX TO EXPEDITE ItEQUE 3. E40W OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINES DAYS <br /> SIGNATURE OF APPLICANT DATE 7r <br /> UNIT DISTRIBUTION O Unit 1 nit 2 ni it 4 Unit 5 O Unit$ 0 Other(electronlcnistsimaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City <br /> 1. b' 6ll�S i <br /> 2. <br /> 3. <br /> 4 <br /> 5. <br /> s. C d1� 450 <br /> LF <br /> 7. - <br /> 8. <br /> 9. <br /> 10. <br /> -�' <br /> Specific[)ate Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT t7$puo WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑F000 FACIUTY t]WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL ❑DAIRY <br /> 11ZHAZARDOUS WASTE GENERATOR O CHICKEN RANCH &WASTEWATER TREATMENT PLANT <br /> El TIERED PERMITTED FACILITY I7 MOTEL/HOTEL .�1 LAND U TRUCKICATION SI t!TOILETS <br /> C3 TATTOOIBODY PIERCING ❑POOLI$PA /v LAND USE APPLICATION SITES <br /> E3 MEDICAL WASTE FACILITY 11 OTHER(PLEASE SPECIFY) <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AtA-6:00PM - 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(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 Tiles 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 /> EHD 42-024)06 -RUS I <br /> 114 AM4 <br />