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EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAY 2 # 2009 600 East Main St, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.s}gov.o <br /> 31 <br /> ENVIRONMENT ICES PUBLIC RECORDS RELEASE APPLICATION <br /> PERI4ifT/�ERVICE� <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: r CiTYISTATErzi S'�e-t a o <br /> PHONE(1): S0 OR C PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 12 CHECK BOX TO EXPEDITE REQUE, » 105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT'.d1�� �� � DATE <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. -~- ❑ Unit 2 <br /> 3. -Jow 4 <br /> - Unit 3 IR <br /> 4. <br /> . S <br /> `- - ---_-- Unit4 <br /> 6. <br /> 7. <br /> 8. <br /> 9. — <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITOR[NG/REMOVAL) DOG KENNEL 0 DAIRY <br /> AZARDOUS WASTE GENERATOR El CHICKEN RANCH rl WASTEWATER TREATMENT PLANT <br /> d TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ©PUMPER TRUCKNARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY i7 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 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 4"6 <br /> 8104l200H <br />