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DATE RECEIVED OAQUIN COUNTY • <br />RE� <br />:::I�N�I� V <br />AL HEALTH DEPARTMENT <br />R 600 East Main St. Stockton, CA 95202-2708 <br />rAky 3 elliflephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRCIMIIENT HEALTHPUBLIC RECORDS RELEASE APPLICATION <br />1'tt'SIVII I1''-' <br />APPLICANT: BUSINESS/AGENCY: <br />ADDRESS: l ( c CITY/STATE/ZIP: <br />PH0NE(1):41e7� _- 4441:5-5g �/p2PHONE(2): FACSIMI <br />TENTATIVE' APPOINTMENT DA <br />(Please allow 10 business da Ir m date of applicati( <br />CHECK BOX TO EXPEDITE REQUE - 15.00 FEE (CASH OR <br />SIGNATURE OF AP <br />EHD LOG NUMBER <br />Time: <br />ittal - *Tentative only - must be confirmed) <br />ONL <br />tt <br />OCESSED IN 3 BU (NESS D YS <br />DATE ad <br />Electronic Information: ❑ ist trMap - Description: <br />please contact Diane Martinez direct) <br />LE ADDRESS <br />EHD USE ONLY <br />El Unit 1 <br />I <br />Street 9 <br />Street Name City <br />1. <br />r <br />I <br />❑ Unit <br />2• <br />3. <br />Ur it 3 <br />4• <br />5. <br />wF �'.fr W . .;� <br />Unit <br />E]Unit5 <br />L8. <br />❑ Unit s <br />5� <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES / <br />RGROUND TANK (UST) CLEANUP SITE (LOP) ❑HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />' OTHER CLEANUP SITE (NON -LOP) El FOOD FACILITY ❑ WASTE TIRE ,Yj( <br />] UNDER OUND TANK (MONRORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />DOUS WASTE GENER�A-;T(OR ❑CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT MI <br />RED PERMITTED FACIL(T p \ ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TATTOOIBODY PIERCING ❑ 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-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 $115.00 deposit prior to review. <br />EHD USE ONLY <br />***if you need further assistance <br />please contact Diane Martinez direct) <br />@ (209)468-3425. Thank You*** <br />6-19-v royi <br />I <br />