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DATE RECEIVED <br /> SAN JOAQUIN COUNTY FHP i_OO NUraBER <br /> ITg@ff R/E[) EN.-rRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> FF/ L my Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw,sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �� J S . �( y�� BUSINESS/AGENCY:_ <br /> ADDRESS: J zl CITY/STATE/ZIP: 7-R Aef T S _�7� <br /> PHONE (1): p f-3 l—q Lf_ PHONE (2): b�_ '7 7�5 _ 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-$125 FEE CASH OPCHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name <br /> City <br /> 1. - __--- -- - - Unit 1 <br /> 7a C 1 �A7 - FJ� �,lJ � -`7, <br /> 2. - <br /> -- -- <br /> 3. --- <br /> -- -- <br /> 4. __- 3 "( <br /> 5. <br /> - —L - - - <br /> -- — --- "t4t4 <br /> 7. - <br /> 8. <br /> 9 [3 Unit 5 <br /> 10. <br /> 6. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES - <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) �F000 FACILITY ❑WASTE TIRE U4 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)D- DOG KENNEL ❑DAIRY , ^J� <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 07 <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING POOLISPA LAND USE APPLICATION SITES <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 un 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. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not retumed 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. <br /> ou <br /> r <br /> I 5 . <br /> �1 z. <br /> 8(,111 <br />