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DA r�l Q7— n. EHD LOG NUMBER <br /> lC;t SAN JOAQUIN COUNTY <br /> ENVIMONMENTAL HEALTH DEPARTNMiXT <br /> DEC ~ 9 t,005 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 3 <br /> ENV1P}OM,6i'-N1-FIEALTH <br /> PEt3[`,!i!'/�S'ERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: eJ`� U{ BUSINESSIAGENCY:JI�P_ S�C�I�'�S� G- e`f��eL <br /> ADDRESS: G 7 %y CITY' �JCf S/ STATE K <br /> PHONE(1): ; 5��.-t 7.5:Z PHONE(2): 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-$93.00 FEE(!CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANfi _ ?`� ��( d% DATE <br /> Electronic ❑ List ❑ Map-Description <br /> Information <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street flame city <br /> 1. <�c-,V-d Unit 1 <br /> 2. <br /> 3. Unit 2 <br /> 4. <br /> 5. �' Unit 3 <br /> 6. <br /> 7. Unit 4 <br /> 8. ieUnit 5 <br /> 9. <br /> 10. i I Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) FOOD FACILITY 52:WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) P.POG KENNEL 'DAIRY <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH 14{�WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIHOTEL r?!rPUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TATTOO/BODY 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-5:00PM - 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 <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 /> n <br /> EHD 48.06 <br /> 10/31/2006 <br />