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05/26/05 THU 13:40 FAX 415 9475 PES ENVIRONMENTAL U11 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HF-ALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 / <br /> 1005 nAY P6 PH 10,11one:(209)468-3420 Fax:(209)464-0138 Web-wwwsjgov.orglehd <br /> SAN J0A0UIN C0uNTRUBLICRECORDSRELEASE APPLICATION <br /> NS EYlviYtyr►1 A� <br /> EF 4 BUSINESSIAGENCY: <br /> APPLICANTt D ' ' O J G IDO OY <br /> ADDRESS: ILO Qqq FACSIMILE:: �5� � <br /> PHONE 111: (S—CJ I I (9 PHONE(2): <br /> Time:�— <br /> TENTATIVE*APPOINTMENT DATE: bml a va ly-must be confirmed) <br /> (Please allow 10 business days from��TTm//rriiii//////aey� <br /> QU T PROCESSED IN 0 BUSINESS DAYS <br /> ❑ CHECK BOX TO EXPEDITE REO EST-$93.ESfE R CK <br /> DATE .5>'2(0 <br /> SIGNATURE OF APPLICANT <br /> UNIT DISTRIBUTION <br /> ❑Untt1 ❑URit2 ❑Untt3 ❑Unit4 ❑Unit5 13UnitS O other(electronlcAistelmlaPs) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Namo City -4e- <br /> e-Q.24Z.- <br /> 2. <br /> . <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. to <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑HOUSING ABATEMENT [3 SOLID WASTE FACIUTYNEMCLE <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) pFOOD FACILITY CI WASTE TIRE <br /> HER CLEANUP SITE(NON•LOP) D00 KENNEL ❑DAIRY <br /> NDERGROUND TANK(MpWTORUIGIREMOVAL) ❑WASTEWATER TREATMENT PLANT <br /> ❑CHICKEN RANCH ❑PUMPER TRUCIUYARDICHEM TOILETS <br /> OOUS WASTE GENERATOR MbTELAiOTEL <br /> 1TATTERED PERMITTED FACILITY ❑POOL<SPA LAND USE APPLICATION SITES <br /> OOA3DDY PIERCING ❑OTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW . MONDAY-FR <br /> 8:00 AM-S:OOPM EXCLUDING HOLIDAYS, <br /> e. Select the <br /> s f rorn the list <br /> ve by Checking the <br /> 1. List up to ten addresses in the space typMUST be selected.type(s)Faxftoe 209 464-0138 Oroma l to the address <br /> appropriate box(es). r least one file type <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,Contac <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 Im m offive <br /> business <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five <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 recant d will <br /> requi e a$93.00 deposit staff a retheexpense <br /> xpense of the <br /> applicant Future file reviews by the same app Y <br /> }a <br /> EHo aso:eos <br /> +nude <br />