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EHD LOG NUMBER <br /> DATE RECEIVED u SAN JOAQUTN COUNTY �r <br /> IiNVI.R.ONMENTAL HEALTH DEPAlITMENT <br /> 600 East Main Street, Stockton, CA 95202-2708 <br /> Telepbnne: (209)468-3420 Fax: (209)464-Ot38 Web: www.sigov.o d <br /> PUBLIC RECORDS RELEASE APPLICATIO <br /> APPLICAN «• /GK BUSINESSIAGENCY: <br /> ADDRESS' 1-t �7�T/1-,i5Y 44010 �/�q <br /> PHONE(t): 9�G SG�' /�2�d PHONE(2):�J �f' _ ___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 REQUEST•$9 .00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SIN SS DAYS <br /> SIGNATURE OF APPLICANT —PATE <br /> Electronic Information: ❑ List[] Map-Description: <br /> FILE ADDRESS _ EHD•USE ONLY <br /> [ Strocl q Street Name City El Unit 1 <br /> 4. r/�9 _�-,- - � 9 / — L N -a c0 UnIt 3 <br /> nit 4 f/ <br /> 1� 7. ' ..; ❑ Unit <br /> 10 <br /> 8. l <br /> 9. ❑,-Unite• . <br /> SpecificDate Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> THERCLRO ANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE r <br /> NDERGROUND TANK(MONITORINGIREMOVALlk 0 DOG KENNEL I] DAIRY le �✓ <br /> AZARDOUS WASTE GENERATOR 0L ❑ CHICKEN RANCH O WASTEWATER TREATMENT PLANT ff ',^I <br /> ❑TIERED PERMITTED FgCILITYp� O MOTELIHOTEL 13 PUMPRR TRUCKfYARDICHW <br /> EM TOILETS T I <br /> Ll TATTOOIBODY PIERCING M POOLISPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE rACiLtTY 0 OTHER(PLEASE SPECIFY) Y�CI <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw - MONDAY•FRIDAYS:OO 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(os). At least one file type MUST be selected. Fax to(209)464.0130 or mail to the address indlcoted 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 now 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 /> *"* contact Diana Martinez GT (209)468-3425 directly. Thank You*** <br /> If you should need further assistance please <br />