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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> KVENVIRONMENTAL HEALTH DEPARTMENT <br /> 11 33 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIR011EPN' HE,•'�T Ilephone: (209) 468-3420 Fax:,(209) 464-0138 Web: WWW.sjgov.org/ehd <br /> `7 <br /> PFRhliIT'SI- <br /> RVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .�� �( ��5 / { BUSINESS/AGENCY: ` - <br /> ADDRESS: ��� > � �7 ctrr 14149 City/State/Zip <br /> PHONE(1 - PHONE(2): FACSIMILE:h—,<21)Z�V-3 eS_ <br /> TENTATIVE*APPOINTMENT DATE: �� � Time: <br /> (Please allow 10 business days from'date of a plicatic submittal-'Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQU $105 FEE(C R CHECK,ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLICANT �^�.1 - � DATE <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> Unit 1 <br /> 2. 3 it lI « K � �ot) IVB 1 ds� �bYl i Unite " \ <br /> 3. s <br /> `r \� <br /> 4. clG'e liNOIA/5P Unit <br /> 5. ` <br /> 6 ")�/� Unit 4 <br /> 7,A vl Z^� 1� PJ C(b <br /> 7. Al ITA21VNI5057 ❑ Unit <br /> 8. z , �a �S, N� x,16, <br /> 9. .32 V� pE I,r_,C-ti�.� <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH EPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br /> X OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> 131 UNDERGROUND TANK(MONITORING/REMOVAL 13 DOG KENNEL 13 DAIRY <br /> WHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 1 <br /> ❑TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM 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 above464-0138 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> c7 X19 Cts a <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />