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7 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> R®������® ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> OCT I 1 jfllephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> RMIT SERVI ES <br /> � �I 1 <br /> APPLICANT: .s i�v ",6 BUSINESSIAGENCY: <br /> ADDRESS: C---FCITY/STATE/ZIP: TU <br /> PHONE (1): _Z'*'T- V d S- X413 PHONE (2): 2-ocl S""1 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 225 FEE (CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE��� <br /> Electronic Information: ❑ List❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. �//J2 352 6 �S' r <br /> 2. � b r HR>�fL_ W %o9,< 'Af 352_(p ❑ Unit 2 <br /> 3. <br /> 4. Unit 3 I� <br /> 5 Ia <br /> 6. it 4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> El s <br /> Specific Date Range of Information Requested: From to <br /> 11 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTER CLEANUP SITE(NON LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> Q I�NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> [,] ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY 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 /> I. 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(es). At least one file type MUST be selected. Fax—t91209)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. <br /> EHO USE ONLY <br /> EHD 46-06 R1111i <br />