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vr%ar-nc�-cww T ---- -- - •-- ---- <br /> �, SAN JOAQUIN COUNTY <br /> •ENVIRONMENTAL HEALTH DI'1PARTmFNT <br /> 304 East Weber Avenue, 3fd Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"r'entauve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ _ DATE <br /> tim r DISTRIBUTION 17 Unit 1 ❑Unit 2 ❑Unit 3 ❑ Unit 4 ❑ Unit 6 ❑ Unit 6 E] Other(electronicn€stslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Street Name city <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. . . <br /> 9. <br /> 70. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HousING ABATEMENT ❑Soue WASTE FAcuTYNrmcLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOYAL) ❑DOG KENNEL Q DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERmiTTED FACILITY 0 MOTELMOTF.L ❑PUMPER TRucK1YARD/Cmm TotLETs <br /> 17 TATTOOIBODY PIERCING '❑POOLISPA 13 LAND USE APPL.ICAT*1 SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT REcORDs ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY e:00 AM-6:00pu - EXCLUDING HOLIDAYS.- <br /> 1. List up to ten addresses in the space above. Select thetype(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,contact <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 <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 fife 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 depositprior to review. <br /> R <br /> EHD 48-02-006 <br /> 1112=4 i <br />