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DATE RECEIVED <br />_ SAN JOAQUIN COUNTY ...:. <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />`) 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />Vv` I <br />DV <br />EHD LOG NUMBER <br />PUBLICRECORDS RELEASE APPLICATION <br />APPLICANT: may G (-e!] 4 I I BUSINESS/AGENCY: �61 r Vl C C <br />ADDRESS: _InA Sri— CITYISTATE/ZIP: (A 1411-1 <br />PHONE (1): �(� �. - PHONE (2): FACSIMILE: <br />TENTATIVE ��APPOINTMENT DATE: Time: <br />(Please allow 10 bus lness days from date of application submittal -'Tentative only -must be confirmed) <br />❑ CHECK BOX TO EXPEDfTE REQUEST - $12 (CA/g�yl,��R CHECK 0 LY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT /� DATE <br />Electronic Information: ❑ List ❑ Map - D Iption: <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />Street s <br />Street Name <br />City <br />Inc! s1 Dr <br />N� <br />❑ Unit 2 <br />2. <br />3. <br />2 -nit 3 <br />4' <br />5. <br />❑ Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />6. <br />9. <br />❑UnN6 <br />10. <br />tt <br />17 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />] UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />] OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE WU'I, <br />HDERGROUND TANK (MONITORINGIREMOVAL) X ❑ DOG KENNEL ❑ W <br />DAIRY , I _�; <br />J HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT 11-0 11 <br />TIERED <br />] TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />] TATr001BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SrrES <br />] MEDICAL WASTE FACILITY ❑ COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (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 appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mall to the address Indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />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 approximately ten (10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br />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 application may be <br />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 applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />