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DATE RECEIVED p, _ EHD LOG NUMBER <br /> - -� = - SAN JOAQUIN COUNTY — - <br /> �� ENVIRONMENTAL HEALTH DEPARTMENT <br /> :i <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> !-w'j i 0 I,09 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.o <br /> TH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: & -- - BUSINESSIAGENCY: <br /> ADDRESS:,(/2 ,(— fpr,�� CITYISTATEIZIP��� / 115t2/�: <br /> ,s <br /> PHONE(1): ?_2 PHONE(2): f�a �; �' ��_ FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) ` <br /> ZCHECK BOX TO EXPEDITE REQUEST-S405.00 FEE CASH OR CHECK ONLY)'-REQUEST PROCESSED IN 3 BUSINESS DAY <br /> SIGNATURE OF APPLICANT _. DATE s� D <br /> ;, <br /> Electronic Information: ❑ List❑ Map-Description: i <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 001m, Unit 1 <br /> �' <br /> 2. S ZPl ( � /U. �, Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> IE <br /> 5. <br /> Un 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. ilkF <br /> 9. maw <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: m to <br /> ENVIRONME AL HEALTH DEPARTMENT FILES <br /> td UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ OUSING ABATEMENT ❑.SOLID WASTE FACILITYNEHICLE <br /> OOTHER CLEANUP SITE(NON-LOP) �1 FOOD FACILITY ❑WASTE TIRE' <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 'k 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL LIMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑ POOL/SPA LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) k <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mall 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 busiriess 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 EHI)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 /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 48-06 <br />