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SAN JOAQUIN CO TY a"�LVta IvuMlitK <br /> ° <br /> ENv I,_.JNMENTAL HEALTH DEPARTMm-ANT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> DECL00 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIR4I,IMEV HEALTH <br /> V l 5 PUBLIC RECORDS RELEASIE, APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: ,ta CITY S'7D STATE <br /> PHONE(1): PHONE(2: FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: —^ -( � Q me: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> b eA C ECK BOX TO EXPEDITE REQ -593.00 FEE(CASH OR CHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic ❑ List ❑ Map-Description <br /> Information <br /> FILE ADDRESS <br /> Street# Street NameCity EHD USE ONLY <br /> �• 4 <br /> 2, c ❑ Unit 1 <br /> 3' <br /> 4. �• El Unit 2 1� <br /> s. f Unit 3 <br /> w� <br /> 7. Unit 4 <br /> 8. <br /> L9. ='Unit 5 <br /> 10' <br /> - ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ 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 /> K TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDA -FRIDAY 8:00 AM-5:00PM - 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 <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 app intment 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 file 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 requi e a$93.00 deposit prior to review. <br /> r� <br /> na <br /> EMD 0-oe <br /> !a171f�oa6 <br />