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05/26/05 TUU 13:40 FAX 41 9475 PES ENVIRONMENTAL Q0 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY ' <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT / � � <br /> 304 East Weber Avenue,3's Floor, Stockton,CA 95202-2708 / <br /> 2005 MAY 26 PH` 0,1pne:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd <br /> SAE-,o A 0UIN CouuTWBLIC RECORDS RELEASE APPLICATION <br /> F�.{1 1,.'.. BUSINESSIAGENCY: SV <br /> APPLICANY: D R�rt O� i� ILIO Ov QCT <br /> ADDRESS: I� nL1q FACSIMfLE: 4)Jam'f 'cl—I 0 D' <br /> PHONE(1): AILS—B I 1 -IUQQ PHONE(2): <br /> Time: <br /> TENTATIVE"APPOINTMENT DATE: bin Te ve only-must be eoM rtned) <br /> (Please allow 10 business days trot <br /> ❑ CHECK BOX TO EXPEDITE REO ES7.593. R CK R QUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF OF APPLICANT <br /> UNIT DISTRIBUTION O UnK 1 ❑UnIt2 ❑Una 3 I7 UnR 4 ❑Unn ti ❑ Units C3 other(electronlcllistshnape) <br /> FILE ADDRESS EHD USE ONLY <br /> str.et s <br /> stleat Name city <br /> 2. S <br /> 3. <br /> 4. <br /> S. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 70. to <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> t <br /> ERGROUND TAW(UST)CLEANUP SITE(LOP) l7 HOUSINGOD ABAT ❑WASTE TRE <br /> TY <br /> ER CLEANUP SITE(NON-LOP) O DOG KENNEL ❑DAIRY <br /> ERGROUND TANK(MOmTORRIGIREMOVAL) ❑WASTEWATER TREATMENT PLANT <br /> pOUS WASTE GENERATOR 113 CHICKEN OTELRAN ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑POTELMOTEL ❑LAND USE APPLICATION SITES <br /> RED PERMITTED FACILITY ❑POOL/$PA <br /> D TATTOOA30DY PIERCING ❑OTHER(PLEASE SPECIM <br /> ❑MEDICAL WASTE FACILITY <br /> FOR REVIEW MONDAY-FRIDAY e:00/VA-6:OOPM - EXEXCLUDINGOLI)AYS. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE <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 mall 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 pEHD files exist <br /> application. The ftles <br /> days for review. Appodays after intments ol w 1 be held for a ment for review aximum ll be nof five confirmed <br /> approximate) ten 10)ntments should he scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew <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 /> ews by the same applicant may require a$93.00 deposit prior to review. <br /> applicant Future file revi <br /> EHD 66a2a 6 <br /> 1nY66 <br />