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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> or '11, ENVIRONMENTAL HEALTH DEPARTMENT <br /> =C3 600 East Main St. Stockton, CA 95202-3029 All§ p �yjjTelephone: (209) 468 3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> V d tJ <br /> -T 4, W PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 7 f f _ S . H//XJJ BUSINESS/AGENCY: <br /> ADDRESS: '1(1A61c-y'{0 C:� /g CITY/STATE/ZIP: G� �jS X76 <br /> PHONE (1): � 7-3 01-tf(3 LL PHONE FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tenta#ve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEECASH O HECK 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 CityUnit 1 <br /> �• 7o G I � L <br /> 2. <br /> ni12 <br /> 3. <br /> 4. — 1 <br /> _ ,Y� Unit 3 iql <br /> 6. <br /> - -- -- ---- ---- nit 4 <br /> 7. <br /> 8. -- <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑unit 5 <br /> Specific Date Range of Information Requested: From to <br /> '''' ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ����7TTTiiiivvv�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E:1 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/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-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 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 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 /> EHD USE ONLY <br /> EHD 48-06 <br /> BN111 <br />