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SAN JOAQUIN COUNTY <br /> l EN4INMENTAL HEALTH DEPARTA%,T <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 q10 <br /> ^Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orglehdl / <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: •^ O 410 BUSINESSIAGENCY: <br /> ADDRESS: 122, a-oS�-N„9„i e h-' A S`I�1J �1 `i S Zc�7 <br /> PHONE(1):-2oj-,S9/-Z99/ PHONE(2): 709-957-303/ FACSIMILE: Z-Ori -gE7-Z6Z.6 <br /> TENTATIVE`APPOINTMENT DATE: Time: tampA <br /> (Please allow 10 business days from date of application submittal-•Tentadve only-must <br /> _\ ❑ CHECK BOX TO EXPEDITE REQUEST• 93.00 FEE(CASH OR CH NLY)-REQUEST PROCES <br /> ' SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Wdt 2 ❑Unit a ❑ Unit 4 ❑ Unit 6 ❑ Unit 6 ❑ Other(electronicllists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> street I Street Name City <br /> �l 1. <br /> Sb 0/ s c, STGTck <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> jUUj <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> '.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILrrYNEMCLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE _ <br /> UNDERGROUND TANK(MONITORING/REIAOVAL) 13DOG KENNEL 11 DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑M6TEUHOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOQIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY - ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REv1Ew- MONDAY-FRIDAY 6:00 Am-6:00PM - 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 1111119 <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 EHD 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 4e424m <br /> lln=4 <br />