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- <br /> -~. <br /> - <br /> DATE RECEIVED <br /> SAN JOAQUIN�`x� E*oLOG NUMBER <br /> _=uENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3 3'd Floor, Stock-ton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:A-ww.Sjgov.org/eh q <br /> t3 <br /> PUBLIC RECORDS RELEASE APPLICATION AP <br /> TENTATIVE*APPOINTMENT DATE- Time: <br /> (Please allow 10 business days from date of application submittal-'TentRtive only-must be c;W-irmed) <br /> TE REQ -19101 EE <br /> CHECK BOX TO EXPEDITE REQ T-$95.00 EE OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Inforrnation: List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Unit I <br /> Street# Street Name city <br /> Unit 1 <br /> 2. El Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 6. n Unit 4] <br /> 7. <br /> 9. C> <br /> 10. Unit <br /> Specific Date Range of Infonmation Requested:From _0Z 0 P to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> _f1TDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING A13ATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> . HER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY 13 WASTE TIRE <br /> 4WUNDERGROUND TANK(MDNITORINGIREMOVAL) 13 DOG KENNEL <br /> HAZARDOUS WASTE GENERATOR 0 DAIRY <br /> C1 CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACIL17Y C]MoTEL/HOTEL 13 PUMPER TRUCKfYARDICHEM TOILETS <br /> 13 TATTOOIBoDY PIERCING 0 POOLISPA 1-1 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY El 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'fi I'e type MUST be selected. F-ax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be <br /> 3:OVpmwill bppnoxwsaccepted <br /> ed� e ,for additional----'~~''~~ ~^''file addresses,contact the Enu'Appxoauonneccivauafter <br /> ext business day. <br /> 2. The EHDmi||notify the applicant if any EHofiles exist An appointment for review will bonunfinnedapproximately ten(1V) <br /> days after receipt cnapplication. The files will unheld for amaximum cf five business doymfor review Appointments <br /> anoumueauhnuu|adouunrding|y. ' <br /> 3' A file that is actively being worked on by EHD staff may not be immediately available for review. Anew 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$95.00 deposit prior to review. <br /> EHDUSE ONLY <br /> ` <br /> EHD 48-06 9114/2006 <br />