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DATE RECEIVED 0 itEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENTE <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov.or 1 <br /> 4? <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �� + /�� f -y'r�� BUSINES AGENCY: <br /> ADDRESS: L'' _�/ c `,3 ��1�;1,' 1 (" <br /> PHONE(1):r'�C ' � C1 f� � PHONE(2): �� `/' ? � ,'�tfFACSIMILE:r' i <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 REQ EST.$98.0 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN �. DATE -7 <br /> SIGNATURE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 2• ?'r � ' / ''Z a Mfr �r�1'.�°s ' rT"_ 1 S\f ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 ' <br /> 5. <br /> 6 OW'Unit 4 <br /> �10 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ,.,,� ENVIRONMENTAL HEALTH DEPARTMENT FII�LES �, <br /> ,�,`UNp ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT n 50 _ T ' A 5 ICLE <br /> ��,V��TH-ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WA <br /> O- NDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAI <br /> W-114�ZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 WEB 8/8/2007 <br />