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VIIIC l�CVCIYCV _ <br /> SAN JOAQUIN COUNTY <br /> WnEC E f/Err EM IMNMENTAL I-IEALTII DEPARTM�rlT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> SEP o Z005Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PJ1:fiErd? NEAJ6PUBLIC RECORDS RELEASE APPLICATION <br /> Rh <br /> AppLICPA�tI': \\c�r;'I�� V �A BUSINESSlAGENCY: _ <br /> ADDREss: <br /> PHONE(1):2- �?/7 -CtJ hti PHONE(2): 1�`l � �1 7�-`Z) ACSIMILE: <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.$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT -- DATE <br /> UNIT DISTRIBUTION ❑ Unk 1 ❑ U ni nit 4 ❑ Unit 6 ❑ Unit 6 ❑ ONIer(electronicAistslmaps) <br /> 6;1 <br /> FILE ADDRESS EHD USE ONLY <br /> Street If Street Name City - G1 <br /> /'/'4 <br /> 2. C' l <br /> 3. 1 <br /> 4. 1 <br /> O189LO 6. <br /> 7. <br /> b Mb <br /> , <br /> Specific Date Range of Information Requested: From to t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FAcLrTYNEHICLE - <br /> OTHER CLEANUP SITE(NoN4.OP) 11FOOD FACILITY ❑WASTE TIRE <br /> X.UNOERGRouND TANK(MowToNGIREMOVAL) E3 DOG KENNEL ❑DAIRY <br /> m <br /> HAZARDOVs WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PFRumfD FAc;uTY ❑M6TELIHOTEL ❑PUMPER TRucWARDICHEM TOILETS _ <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDIC/LL WASTE FACILITY - ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 6:00 AMb: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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contac <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD -02A06 <br /> atnwa <br />