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D T�t2ECEIVED EHD LOG NUMBER <br /> n � �`\/]En SAN JOAQUIN COUNTY <br /> v ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 q <br /> Alli �, 2006 <br /> � Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTtAjTLQ-Q I j(,r(Z PUBLIC RECORDS RELEASE APPLICATION <br /> r <br /> A PLICAN oa, BUSINESS/AGENCY: <br /> ADDRESS: 3 <br /> PHONE(1) _ �� PHONE( ): O FACSIMILE: )O <br /> TENTATIVE'APPOINTMEIN'f(bA`iE: Time: <br /> (Please allow 10 busine ays from date df application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE T-$9 0 FEE CO HECK ONLY)-REQUEST PROCESSED IN 3 USIN SSD YS <br /> SIGNATURE OF APPLICANT DATE �I <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Uni nit nit 5 ❑ Unit 6 ❑ Other(electronicflists/maps) <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Namp Cit <br /> 1. a none <br /> 2. <br /> 3. I 1 1 <br /> 4. b t l 1 <br /> 5. <br /> 6. <br /> 7 <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to a'>` <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES l'L <br /> r � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE tlr��': <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR 13,....,,,,////CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY OTEL/HOTEL I ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> 13TATTOO/BODY PIERCING ❑ POOL/SPA ��❑LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AMS:0OPM - 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 t . eview. <br /> tF: <br /> EHD 4"6 <br /> 611/06 <br />