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DATERECEIVED SAN JDAQUIN COUNTY - _ EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: 1Nww.sjgov.or <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��i ' ( BUSINESS/AGENCY-. ,!U'E � ^ 7� <br /> ADDRESS: Z 7 ��'IC � / CITYISTATEIZI P: �il-7 � <br /> PHONE (1): , 5,G ` ^Ci '� PHONE (2): _ FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> X (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> I Street# Street Name City Cl Unit 1 <br /> L't, 424-7 Ur✓' <br /> 2. if f:'_"l /Viv IQ4! lr nit 2 r <br /> 3. C1 4. _ <br /> 2 )ena ve ,jenit 3 <br /> i <br /> nit 4 <br /> 7. I <br /> ❑Unit 5 <br /> f - -9-- <br /> 14 <br /> .. ❑ Unit s <br /> Specific Date Range of Information Requested: From to <br /> � ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'CJ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> ❑SOLID WASTE FACILITYNEHICLE <br /> JaOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ,`UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ,2 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA JZ 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 mail 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 END 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$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE MY <br /> EHD 46-06 8127100 <br />