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SAN JOAQUIN COUNTY ". <br /> ENv�v6NMNTAL HEALTH DEPARTAI tlT <br /> 304 East Weber Avenue, 3"Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: vVl 0 U >�G ckk <br /> BUSINESS/AGENCY: K e VE <br /> ADDRESS: -C F(, � 111 L V <br /> �J k'Ta Q 'F <br /> PHONE(1): — S PHONE(2): I D"i 3<1 3 y 7 <br /> FACSIMILE: <br /> T ATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business daysfrom date of Time: <br /> application submittal- Tentadve only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQU $93.00 AS CK ON REQUEST PROCESSED IN 3 BUSINE40 DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> UNIT DISTRISUTK>H ❑Unit 1 ❑ nit 2 ❑Unit 3 ❑ Unit 4 13 Unit 5 ❑ Unit 6 ❑ <br /> Other(elecbVnWlsts/maps) <br /> FILE ADDRESS <br /> Stroma StrsetName city EHD USE ONLY <br /> 2. <br /> 3. <br /> 5. \� <br /> 6. <br /> 7. <br /> 8. <br /> 8. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> TANK(UST)CLEANuP SITE(LOP) (3HOUSING ABATEMENT E3SOLID WASTE FACMJTY/VEHICLE <br /> PSITE(NM4.Cf P) 13FOOD FACILITY 13WASTETIRE <br /> 0— �EE <br /> TANK(MON00 &G REMOVAL) C3DOG KENNEL C3DAIRY , <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATiiENT PLANT <br /> C3 TIERED PERWnw FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> E3 TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SiTES <br /> E3 MEDICAL WASTE FACILITY ❑OiHER(PLEASE SPEC <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAY& <br /> 1. List up to ten addresses in the space above. Select the types)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 appointment 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 require a$93.00 deposit prior to review. <br /> EHD Np <br /> IM40" <br />