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{ <br /> DATE RECEIVED it '` EHD LOG NUMBER <br /> © SAN JOAQUIN COUNT=Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> APR Z 4 2009 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwAgov.or <br /> NVIONMENT HEALTH PUBLIC RECORDS RELEASE'APPLICATION <br /> APPLICANT: EIUSINESS/AGENCY: <br /> �( ADDRESS: _,_CITYISTATEIZIP 5 GAG' <br /> PHONE(i):� �� _ PHONE(2): FACSIMILE: !� <br /> I` TENTATIVE*APPOINTMENT DATE: I Time: <br /> (Please allow 10 business days from date of application submittal-'.Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE T-5105.00 FEE(CASH OR CHECK ONLY -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �� ?d <br /> i! <br /> �ectronicnformation: ❑ List❑ Map—Despription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Str et Name City ❑ Unit 1 <br /> G <br /> 2. ❑ Unit 2 <br /> 3. �J <br /> 4. Unit 3 Y <br /> 5. <br /> Unit 4 <br /> 6. <br /> a <br /> 7. I, <br /> 8. ❑ Unit 5 <br /> 9. <br /> ❑ Unit 6 <br /> 10. ; <br /> Specific Date Range of Information-Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDER <br /> GROUND TANK(UST)CLEANUP SITE{LOP <br /> ) ❑ <br /> HOUSING ABATEMENT C <br /> SOLID WASTE FACILITYN H E I <br /> cLE <br /> 4�60THER CLEANUP SITE(NON—LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> `®°UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 13 DAIRY <br /> s ©HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> f ❑TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMTOILETS <br /> ❑TATTOOBODY PIERCING ❑ POOLISPA ❑ LAND 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-5.04PM — EXCLUDING HOLIDAYS. <br /> 1. List up-to ten addresses in the space above. Select the type(s)of files from.Ithe 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'.TevieWmAll be confirmed approximately ten(10) F <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. a <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$105.00 deposit prior to review. <br /> f - <br /> EHD USE ONLY Il <br /> 'If you need further assistance please contact Diane Martinez C:(209)468-3425 directly. Thank You*** <br /> 4 <br /> EHD 48-06 -. <br /> - 8104/2008 <br />