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6ANJOAQUIN COUNTY "�vV14kAVIULK <br /> ENV,I 1MENTAL Y3EALTIi DEPARTME <br /> 304 East W r Avenue, P Floor, Stockton CA 95207 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov.org/eh <br /> { PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: . 5 A-t �,/ 11 <br /> BUSINESS/AGENCY: <br /> ADDRESS: 2- $ �� S,Cil�ij <br /> PHONE(1): CITY <br /> STATE��^ <br /> _—�o� �- Q q 1 6�j�� PHONE(2}: tO°� C{ �j <br /> FACSIMILE: <br /> TENTATIVE'APPOINTMENT'DATE: l <br /> i. Time: <br /> (Please allow 40 business days from date of application submittal-'TentUve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE C SH OR CHECK ONLY) ' <br /> •REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 -- <br /> Electronic ❑ List ❑ Ma Descd <br /> Information P- ption <br /> FILE ADDRESS <br /> Street# Street Name City 4 EHD USE ONLY <br /> 2. �. ❑ Unit 1 <br /> 3. <br /> 4. ❑ Unit 2 <br /> s. Unit 3 <br /> 7. � W, <br /> �. i Unit141 . <br /> s. 0 Unit 5" <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES . <br /> NDERGROUND TANK(UST)CLEANUP SITE LOP ❑ SOLID WASTE FAcILITYNEHICLE <br /> (LOP) HOUSING ABATEMENT i CI <br /> �THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL s ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBOOY 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-5:0OPM - 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 fora 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 /> EHP 48-06' - <br /> 1 013 112 00 6 <br />