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_PAI&RECEIVEDEHD LOG NUMBER <br /> Ull <br /> E C�� V ELD) SAN JOAQUIN COUNTY � <br /> `/ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> a <br /> At 2 2 2006 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd a <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: Ot <br /> PHONE(1) hA XX��n(��PHONE( ): d FACSIMILES O <br /> TENTATIVE"APPOINTMENT' &: Time. <br /> (Please allow 10 busine ays from date f application submittal-•Tentative only-must be confirmed) <br /> yCHECK BOX TO EXPEDITE T-$9 0 FEE C �O HECK ONLY)-REQUEST PROCESSED IN 3 USIN SS DPjYS <br /> SIGNATURE OF APPLICANT DATE I <br /> UNIT DISTRIBUTION ❑Unit 1 ❑Unit 2 ❑Uni nit nit 6 ❑ Unit 6 ❑ Other(electronicAists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Namr. Cit <br /> F35.. <br /> a b t1 Z <br /> 6. _ <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to _ k7,010 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES rr; 6 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE .c <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ���❑,,,///CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY MOTELMOTEL t � �PUMPER TRUCK/YARD/CHEM TOILETS . <br /> ❑TATTOO/BODY PIERCING '❑ OOL/SPA 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 AM-B: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 <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 /> EHD 1846 <br /> all= <br /> d <br />