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rom <br />From: Christopher Robin 9 Fax: +1 (209) 464-0138 ige 1 of 1 7/27/20119:16 <br />D Ce, <br />� EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />,,,-T�"hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />�NVI M isEa�,C-"ES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: { 1 .- BUSINESS/AGENCY: <br />ADDRESS: CITY/STATE/ZIP: <br />PHONE (1): PHONE (2): FACSIMILE: <br />TENTATIVE' APPOINTMENT DATE: Time: _ <br />(Please allow 10 business days from date of application submittal - "Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $122 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT is +` ; DATE <br />Electronic Information: ❑ List ❑ Map – Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />_ IV, Unit 1 <br />Street # <br />Street Name <br />City <br />1 <br />o wryr <br />N �,10oUni13c-A'5P A1 <br />2 <br />2 <br />3.cor5r <br />-- <br />�1Unit <br />—)v <br />•`rUnit 3 <br />4. <br />_ ... <br />5. <br />Unit 4 <br />❑ Unit 5 <br />6. <br />7. <br />_ <br />8. <br />9. <br />_ <br />0 Unit <br />10. <br />Specific Date Range of Information Requested: From -I to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE Q <br />® OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE �I ` <br />® UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ® WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA ® 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-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 mail 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 $122 deposit prior to review. <br />EHD 48.06 <br />