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SAN JOAQUIN COUNTY <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />�',T 2+J07 600 E. Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjg0v.or ehd <br />E!' ViRC'lN10f:'NT HIE � �ffi <br />f'.i�i5lifiJS PUBLIC RECORDS RELEASEAPPLICATION <br />END LOG NUMBER <br />1,50 <br />APPLICANT: 4 ! tv. BUSINESS/AGENCY: 6) 4::i � �o <br />ADDRESS: S -- <br />PHONE (1): FACSIMILE: r12 9`'� �.�`-�, <br />TENTATIVE* APPOINTMENT DATE: �^ ��� <br />(Please allow 10 business days from date of application submittal - *Tentative on yl- must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - 95.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICAN <br />DATE <br />�11W%,L1W11,k. 1119VIIIIQLIv[1: LJ LIS[ L_j Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City ❑ Unit 1 <br />2. <br />❑ Unit <br />3. <br />4. <br />Unit 3 <br />6. <br />6.r <br />Ik 4 <br />7. <br />❑ Unit -5 <br />8. <br />9. <br />❑ Unit6.. <br />10 <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />�UCI <br />TANK (UST) CLEANUP SITE (LOP) 13 HOUSING ABATEMENT C3 SOLID WASTE FACILITYIVEHICLE <br />THER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL - ❑ DAIRY <br />O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />Q TIERED PERMITTED FACILITY 1:.7 MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ 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 mall 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 $95.00 deposit prior to review. <br />EHD USE ONLY <br />3"� <br />