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UI11 C I:CIitI VCU _ <br />L - SAN JOAQUIN COUNTY EHD LOG NUMBER E V <br />ENVIk',6NMENTAL HEALTH DEPARTM&f <br />MAR - 2 2006 304 East Weber Avenue, 3' Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 We: www.sjgov:org/ehd <br />ENVIROf�WENT HEALTH <br />2mq!57 <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: =�/myy) , p BUSINESS/AGENCY: <br />ADDRESS: _ ,l/i Mn,c! Rh k) , a (I>.-, CITY_51313, %d STATE / 2 <br />PHONE (1): C'�IO�It�C/ ^�/L/%i PHONE (2); �Q�i % _ fj (9S' FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />13 CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �✓ <br />Street # <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />i. <br />8. <br />0. <br />❑ List ❑ Map - Description <br />LE ADDRESS <br />Street Name <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />DATE o3-Do2-D <br />EHD USE ONLY <br />?S Unit 1 <br />O Unit 2 <br />Ile' Unit 3 3\i0 <br />O�y4* <br />.Unit 4 <br />El Unit 5 <br />O Unit 6 <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />P'bTHER CLEANUP SITE (NON -LOP) 93fOOD FACILITYQ'U13 WASTE TIRE <br />NDERGROUND TANK (MONITORING/REMOVAL) El DOG KENNEL E3 DAIRY <br />�iAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />CKERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES 1 <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <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 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 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 S93_0o ripnncit nrinr +„ re%Al .., <br />10131/2006 <br />