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R SAN JOAQUIN COUNTY <br /> . -- EN' `ONMENTAL HEALTH DEPARTIVI-- <br /> IT <br /> y,j -�Y 31 2.011 6'UI�East Main St. Stockton, CA 95202-302 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTALHFJlM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �t �`\�, [� C!� `< BUSINESS/AGENCY: L� <br /> ADDRESS: PO 4o ,&qk1 CITY/STATE/ZIP: c� 1 <br /> PHONE (1): 0.Dcj ❑-D�.1�,t0,� C1'1 <br /> ��a- 0`1 C)b PHONE (2): (�� Irl t� FACSIMILE: <br /> TENTATIVE APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST 122 FEE(CASHQR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1 t 1 <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> —_ FILE ADDRESS EHD USE ONLY <br /> Street# Etreetam4 City <br /> Unit 1 <br /> 2. <br /> 3. ❑ Unit 2 <br /> 4.5. — -- - ---- -- Unit 3 <br /> ----- <br /> 7 -- Unit 4 <br /> 9. ------- Un it 5 <br /> 10. <br /> nit <br /> Specific Date Range of Information Requested: From ( q� ,(� ��0 V to CkX 'e�A7 <br /> ENVIRONMEN AL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOL/SPA ❑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-5:00PM(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 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 /> EHD USE ONLY <br /> EHD 48-06 <br /> 07/29/10 <br />