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i� EHD LOG NUMBER <br /> SAN .10AQUIN COUNTY <br /> 8 �1 Jp1k ENVIRONMENTAL HEALTH DEPARTMENT ^ \� <br /> F� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 . <br /> EN p MtTIg.Vo'kT ne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: CITYISTATEIZIP: <br /> PHONE(1):� -� PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMEN DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSE11.1N3-BUSINESS DAYS <br /> SIGNATURE OF APPLITANT L— -- D✓ATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> i <br /> Street# Street Name City j7I Unit? <br /> 1. y ntxcYptzn;�_�. <br /> 2. dUnit2 <br /> 3. 779 <br /> 4. IZ] Unit 2 <br /> 5, ,,tS <br /> 6. LJ Unit4 <br /> 7. 1" <br /> g, Unit 5 <br /> 9. <br /> 10. ZUnit 6 <br /> Specific Date Range of Information Requested: From t-5/} to 2 2.l <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FAclUTYNEHICLE 'A'kv <br /> []]OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE I <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) []]FOOD FACILITY DAIRY ABOVEGROUND TANK d]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Listup fo 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$125 deposit prior to review, *"BOXED AREA-EHD USE ONLY*'* <br /> Z Zs l� rodid 1 o t 1 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 9wiz <br />