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From Chris topherRo in � SAN JOAQUIN COUNTY)G87-6443 To. Fax: +1 12091 454-013H Page 1 of 1 7/2712011 9:16 <br /> ,�� <br /> D �� EHD LOG NUMBER <br /> �,� 2�� ENVIRONMENTAL HEALTH DEPARTMENT �+ <br /> UL 600 East Main St. Stockton, CA 95202-3029 <br /> Jhone: <br /> ���p (209 <br /> )468-3420 Fax: {209}464-0138 Web: www.sjgov:orglehd <br /> ,Ep1�1tM�sR��C�s PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: CITYISTATEIZIP: ---- <br /> PHONE(1). <br /> _ PHONE(2): _ FACSIMILE: s <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 S122 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 /> Street# Street Name City ❑Unit 1 <br /> I <br /> -01 <br /> 0,04 a <br /> 2.. - _ Unit z <br /> 3. <br /> 4. <br /> Unli 3 <br /> 5. <br /> 6. 11 <br /> Unit 4 <br /> 7. <br /> 8. - <br /> ❑Unit 5 <br /> 9. <br /> 10. 0 U.it <br /> Specific Date Range of Information Requested:From wl, s to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG FENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOII300Y PIERCING ❑POOLISPA ®LAND USEAPPUCATION 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 12091464.0138 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 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$122 deposit prior to review. <br /> _ EHU USE ONLY _ <br /> EHO 48-06 07rlW1 a <br />