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.� ECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �17 / v <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 ,VI[" f <br /> Al l G 2 2 2006 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: -' � 3 <br /> PHONE (1) ��( �� Ll.P� HONE ( ): O Z3 FACSIMILE: 50 <br /> TENTATIVE" APPOINTMEN?�ArE: Time.' <br /> (Please allow 10 busine days from date f application submittal - 'Tenrafive only - must be confirmed) <br /> CHECK BOX TO EXPEDITE T - $9 0 FEE C O HECK ONLY) - REQUEST PROCESSED IN 3 USIN SS DgLYS <br /> SIGNATURE OF APPLICANT DATE A ZI 9 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Uni j;CmI nit 5 ❑ Unit 6 ❑ Other (electronic/listslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 8 - Street Namp Cit <br /> ADyke <br /> 2. 1 2 <br /> 3. Ifn ( ( 1 I <br /> 4. (311 1 <br /> 5, <br /> 6. <br /> 7. <br /> 8. <br /> 91, <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> pA <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES `'`' � A j <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 13 HOUSING ABATEMENT 13 SOLID WASTE FACILITVNEHICLE fd <br /> ❑ OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE t(4�R-A <br /> ❑ UNDERGROUND TANK (MONITORING/REMOVAL) CIDOG KENNEL E3DAIRY �Gr <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> -❑ TIERED PERMITTED FACILITY XMOTEL/HOTEL ( MQI ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 171TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY El 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 <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 $95.00 deposit prior tQkLeview. <br /> fi <br /> - - PPP <br /> - <br /> - - - Y. <br /> END 4646 <br /> B/1106 <br />