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DATE RECEIVED EkD LOG NUMBER <br /> SAN JOAQUIN COUNTY71 <br /> U, <br /> o ��] ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: v/ww.s' ov.or ehd ' <br /> AUG 1 6 2006 �� � <br /> ENABONMENIEFAIT PUBLIC RECORDS RELEASE APPLICATION <br /> PFkFMjykfiR c co BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE(1): r _C(` : ' PHONE(2):Z D C1 a — 3 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business(lays from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE E -;95.00 EE!Ct OR ChtpOK_ONLY)-REQUEST PROCESSED IN 3 8 [NESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> UNIT DISTRIBUTION nit1 ❑ Unit 2 nit 3 nit 4 Unit 5 ❑ Unit 6 ❑ Other(electronicllistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> F2.3i <br /> 4. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I <br /> `t� } <br /> UNDERGROUND TANK(L1ST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON4-OP) 0.FOOD FACILITY ❑WASTE TIRE f"" <br /> Nd UNDERGROUND TANK(MONdORINGIREMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOT'ELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS k <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA 0 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 ANI-5:OOPM - 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 I <br /> appropriate box(es)I At least one file type MUST be selected. Fax to(209).464-0138 or mail to.th' 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. Y <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 to review. <br /> r <br /> c Me i <br /> EHD 48-06 <br /> 8!4!86 <br /> J <br />