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t7HD LUG NUMBER <br /> Un i c nct,ci vCu <br /> r' SAN JOAQUIN COUNTY r <br /> TNS-1*Z7K 'IENTAL REALM DEPARTIME,N7' <br /> - -- - - -- • . . -- =- - GQO East Main Street, Stockton, CA 95202-2708 <br /> T_eleplione- (209) 468-3420 Fax. (209) 464-0138 Web: wv w.Sjgov.or h 3q <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT - �NESSGENCY: <br /> ADDRESS: <br /> PHONE(1): 9Z5-j373-.441 PHONE(2}: 7� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: AS� Time: <br /> (Please allow 10 business days from date of Ap%catioT submittal -*Te tafive only-must be confirme <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 1 .00 FEE(C H CHECK QN )-RE FEST PROCESSED IN 3 BUSINESS DAYS s <br /> SIGNATURE OF APPLICANT / ` DATE <br /> Electronic Information: ❑ LisoMap--D cription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 271 b L5* - <br /> ❑ Unit 2 <br /> 2 <br /> 3. <br /> Unit 3 <br /> 4. ) <br /> 5' Unit 4 `` <br /> 6. <br /> 7. ~— Unit 5 <br /> 8. <br /> 9. nit 6 <br /> 10. <br /> Specific Date Range of information Requested: From to <br /> l/^ ENVIRONMENTAL HEALTH DEPARTMENT FIL <br /> 81 NDERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT � 415 WASTE FACILITYIVEHICLE <br /> ER CLEANUP SITE(NON-LOP) Q FOOD FACILITY 11 WASTE TIRE <br /> ERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> AZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C7 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTODIBODY PIERCING _0 P�OOLISPA ID LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY E OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRSD 8:00 AM-5:40 - EXCLUDING LIDAYS. <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 209 464-4138 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** <br /> if you should need further assistance please contact Diane Martinez C? (209)468-3425 directly. Thank You` <br /> EHD 46.06 9/1412006 <br />