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3; 26rPvi K'_=:i`d iD F, IiVC. NO. 4612 P, 1 <br /> D� EHD LOG NUMBER� SAN �OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPTRILE Copy <br /> 600 East Main St, Stockton, CA 95202-3029WO <br /> �AOYelephone: (209) 468-3420 Fax: (209) 464-0138 Web; www.sjgov,org/ehd fi <br /> zisE�` PUBLIC RECORDS RELEASE APPLICATION <br /> P <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP:- <br /> PHONE (1): :177 'SSPHONE (Z): FACSIMILE:__:f'7 <br /> TENTATIVE*APPOINTMENT DATE; Time: <br /> (Piaase allow 10 business days from dat application subm ttal-*Tentative only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE REQUEST-$122 FE ( AS OR CHECK LY)-REQUE5T PROCESSED IN 3 SUSIN S5 PAYS <br /> SIGNATURE OF APPLICANT DATEdj <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name arty <br /> 1 Unit 9 <br /> UUnit 2 <br /> 3. <br /> 4. <br /> Unit 8 <br /> 5. <br /> s. P RL25 a X337( <br /> rc,(- otl Unit 4( 'I <br /> 7. <br /> L190 <br /> ❑Unit 6 <br /> Unit <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> INN ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> T ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ,�-Wn5'fE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑boo KENNEL ❑DAIRY <br /> L2-ITAZARDOUS WASTE GENERATOR C]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA AND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1, List-up to ton addresses in the space above. Select the type(,$)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$122 deposit prior to review. <br /> END USE ON4Y <br /> 9HD 48-09 <br /> 07/29110 <br />