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Il/'L5/'LVVIS lj :'tf FAY �` EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY Q <br /> ENVIRONMENTAL HEALTH DEPARTMENT, <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (2(}9)46$-3420 Fax: (209)454-0138 Web: vwvw.sigov.org/e d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AFP41CAN7: BUSINESS <br /> IAGENCY: <br /> ADDRESS: <br /> �,( J��(1 �'��� CltylStatelLip <br /> PHONE(1): PHONE(2): FACSIMILE, <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 buninesu days from date of appllcatlon submittal-"tuam lve only-must be conflrmad) <br /> ❑ CHECK BOX TO EXPtDITE RE T-$ 5 FEE(CASH O C ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS AY, <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Infonlnatlon: List[I Map—Desariptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Stteet# Street Name City <br /> � U 1 <br /> r oc�kr.4�� <br /> 2. v unit 2 ' . <br /> 3. `C{ Unit 3 <br /> 5. lo�. �l�5 N . El r�,d►a 5� ��� <br /> 1 <br /> 6. <br /> $. <br /> 9. <br /> Unit 6 <br /> 70. <br /> Specific Date Range of Information Requested:From to ��( ? <br /> ENVIRONMENTAL HEALTH DEPARTMENT-FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 9k HOUSING ABATEMENT $Quo WASTE FACIt_"IVENICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY WASTE TIRv <br /> UNDIERGROUND TANK(MONITORING1REMQ'VAL) DOG KENNEL DAIRYKE <br /> HAZARDOUS WASTE GENERATOR CHICN RANcH WASTEWATER TmATmUfrr PLANT <br /> TIERED PERMITTED FACILITY MflTELIH"yt'- PUMPER TRUCK/YARD/CHEM'TOlLM <br /> TA7Too/BoDY PIERCING OOi1SPA D USE APPLlCA oN SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMft RECORDS ARE AVAILABLE FOR RemFw -MONDAYTRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> i. Llst up to tan addresses in the apace above. Select the type(s)of files from the fist above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 484-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with flle addresses,contact the EI-10. 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 recelpt of application, The files will be held fpr a maximum of five business days f6r 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 fila 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 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-08 a/ma PUBLIC RECORDS RELEASE API'FOfiM <br /> l <br /> I <br />