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- . tr1U LVti NUMHtK <br /> SAN JOAQUIN COUNTY <br /> ENV1 JNMENTAL HEALTH DEPARTMI.. (T <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web : www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _ �Ci..� l; rlyPre� rwtn �.� � 't— n < BUSINESSIAGENCY: <br /> ADDRESS : CITY O � 10 <br /> `^ncl STATE nn� ry <br /> PHONE (1 ): 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 /> ❑ CHECK BOX TO EXPEDITE RE EST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESSDAYS <br /> SIGNATURE OF APPLICANT � , ) � 11n DATE � 44 /A W <br /> Electronic 11 List ❑ Map - Description <br /> Information <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name City <br /> 1 . 1 IV o wt b-tir S LK o s <br /> 2. -II s ,v r4--A b a , >-�r El Unit 1 <br /> ❑ Unit 2 <br /> 4. <br /> s. Unit 3 \� <br /> 7• 0eunit 4 <br /> 8 . <br /> 9 . ❑ Unit 5 <br /> 10. - ❑ Unit 6 <br /> Specific Date Range of Information Requested:ested: From <br /> to <br /> — / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> TH111 E1313RGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> IJ CLEANUP SITE (NON-LOP) FOOD FACILITY ❑ WASTE TIRE <br /> [[ NDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> WIfAAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Aw5:00PM - 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 mall 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 /> Pit <br /> I� <br /> EHO d8-OG <br /> 1013112006 <br />