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EHD LOG NUMBER <br /> DATER <br /> y 6'�S� '� "�"�, • TH SAN JOAQUIN COUNTY DEPAQPY \M\® <br /> NVIRONMENTAL HEALRT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> MAR 0 5l@Ilphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> q \ BUSINESS/AGENCY: <br /> APPLICANT:' 4 T— <br /> ADDRESS: _� LI 4:21 ('V� CITYISTATE/ZIP: Sr1 o�(UtoL� <br /> PHONE (1): 97 7 PHONE (2): ;L!!� • 2-7 / - 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 REQUESs ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS ESS AYS <br /> SIGNATURE OF APPLICANT — '��— DATE 03 'T I2 — <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2 E] Unit 2 <br /> 3. <br /> 4 ❑ Unit 3 <br /> 5. <br /> ❑Unit 4 <br /> 6. <br /> 7. <br /> 8 [IUnit 5 <br /> 9. <br /> 70. El Unit 6 <br /> Specific Date Range of Information Requested: From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F]UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILHYNEHICLE <br /> ❑.OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILrrY WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> '1SJ7"ulAZARDOUS WASTE GENERATOR E]CHICKENRANCH ❑WASTEWATER TREATMENT PLANT <br /> 'MTIERED PERMITTED FACILITY <br /> MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ LAND USE APPLICATION SITES <br /> F1TATTOOIBODY PIERCING ❑POOLISPA ❑ <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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. <br /> submitted when the file is available. <br /> Mf the a <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the exp <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> o EHD USE ONLY <br /> O <br /> o <br /> EHD 6-06 <br />