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r <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-30 <br />I Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />PHONE (11): `)jQ::j(pfh-`I3`'I'1 <br />TENTATIVE" APPOI NTM EN' <br />(Please allow 10 business <br />EHU LU(3 NUMUtIl <br />,g/eh / <br />REQUEST PROCESSED IN 3 BU INESS�AYS <br />DATE Cg7ZJ�/ l0 <br />NO <br />aquasFro <br />m ��rQSe <br />aa--'''' ENVIRONMENTAL ALTH DEPARTMENT FILES <br />�uNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br />ff-OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY El WASTE TIRE �\l� <br />allNDERGROUND TANK (MONITORING/REMOVAL) Ol' ❑ DOG KENNEL ❑ DAIRY ` <br />HAZARDOUS WASTE GENERATOR d� ❑ CHICKEN RANCH <br />TIERED PERMITTED FACILITY (�- .,[��j(',(''ASTEWATER TREATMENT PLANT <br />] TATTOO/BODY PIERCING ❑ MOTELIHOTEL UPUMPER TRUCKIYARD(CHEMICAL TOILET 1 <br />❑ POOLISPA ❑ LAND USE APPLICATION SITES <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 uo to ten addresses in the space above. Select the type(s) of files from thelist above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to 1209) 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 _ dI <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 <br />Future file reviews by the same applicant may require a $115 deposit prior to review. <br />S. If you need further assistance, please contact Diane Martinez, at (209) 468.3425. <br />Eti�,[tire;Tnr,.��ersa�r�. ,n•....:..e�,� - _ <br />mmali- <br />NO <br />aquasFro <br />m ��rQSe <br />aa--'''' ENVIRONMENTAL ALTH DEPARTMENT FILES <br />�uNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br />ff-OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY El WASTE TIRE �\l� <br />allNDERGROUND TANK (MONITORING/REMOVAL) Ol' ❑ DOG KENNEL ❑ DAIRY ` <br />HAZARDOUS WASTE GENERATOR d� ❑ CHICKEN RANCH <br />TIERED PERMITTED FACILITY (�- .,[��j(',(''ASTEWATER TREATMENT PLANT <br />] TATTOO/BODY PIERCING ❑ MOTELIHOTEL UPUMPER TRUCKIYARD(CHEMICAL TOILET 1 <br />❑ POOLISPA ❑ LAND USE APPLICATION SITES <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 uo to ten addresses in the space above. Select the type(s) of files from thelist above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to 1209) 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 _ dI <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 <br />Future file reviews by the same applicant may require a $115 deposit prior to review. <br />S. If you need further assistance, please contact Diane Martinez, at (209) 468.3425. <br />Eti�,[tire;Tnr,.��ersa�r�. ,n•....:..e�,� - _ <br />