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DA I E=KtCtIVED r-nU LUV IVUIVIDr-M <br /> SAN JOAQUIN,COUNT- <br /> E>. . IRONMENTAL"HEALTH DEPAR i idENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0.1.38 Web: www.sjgov.orWehd 05-6 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��' / �Z/�Q2 BUSINESS/AGENCY: <br /> ADDRESS: /Y�P U S. Hzv L a lel"C. C�Fti�L L'�1 n �-�15✓c��t� 0 <br /> PHONE(1): q3,1 // PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: tury <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be*nG Um <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION Uni Unit 2 Unit 3 knit 4 AFFUnit 5 enit 6 ❑ Other(electronic/lists/maps) <br /> FINE AMRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. <br /> 4. ry J <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) JDC( <br /> USING ABATEMENT LID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) DD FACILITY ASTE TIRE ! / � <br /> UNDERGROUND TANK(MONITORING/REMOVAL) G KENNEL ( I DAIRY ( ( C) <br /> HAZARDOUS WASTE GENERATOR ICKEN RANCHl ASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY OTEL/HOTEL PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING 1` OL/SPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY HER(PLEASE SPECIFY)WELL AND SEPTIC PERMIT RECORDS ARE AVAILOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> 1 <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 for a 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 /> EHD 4"2-006 <br /> 11/23/04 <br />