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M' SAN JOAQUIN COUNTY <br /> ENVI.., � MENTAL HEALTH DEPART <br /> 304 East Weber Avenue, 3rd Floor, Stockton, A95202-208 <br /> MIT <br /> r Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.s gv7arg/ehd <br /> Lq <br /> a <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: u i-7" LBUSINESSIAGENCY:ADDRESS: Q� , <br /> PHONE(1): <br /> ' PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE; <br /> (Please allow 10 business days from date of application submittal-'Tentadive only must be confirmed}' <br /> CHECK BOX TO EXPEDITE REQU $93 H OR CK ONL <br /> SIGNATURZt4ZZ0UnF=..Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE �y d <br /> UNIT DISTRIB4 ❑ Unit 5 ❑ <br /> Unit 6 ❑ Other(electronicllisWmaps) <br /> FILE ADDRESS <br /> Street# Street Name Cit EHD USE ON Y <br /> 2.3. <br /> / 1V <br /> 4. 3 <br /> ry t <br /> 6. <br /> 7. <br /> 8. <br /> 70. M. <br /> zc <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT RLES <br /> I <br /> ECNNDERGROUND TANK.(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FAc1UTY/VEHICLE <br /> 'Z OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAcIUTY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCWYARDICHEM TOILETS kkk <br /> In TATTOO/BODY PIERCING ❑POOLISPA "❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVA[LA13LE 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 fora maximum`of five business i <br /> days for review. Appointments should be scheduled accordingly. k <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new f <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. r <br /> r <br /> � I <br /> EHD4MG <br /> 91!4!05 <br />