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DATE RECEIVED / EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> if jENV'r76NMENTAL HLfi'EALTH DEPARTMT <br /> 600 East Main Street, Stockton, CA 95202-2708 7 <br /> _i€i t. % .1,; r!,C 8 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov o e o13 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D BUSINESS/AGENCY: <br /> ADDRESS: 19 01A I CC) <br /> PHONE(1): �� ' 5-5 QI ( �—j PHONE(2): C FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE R E $98.00 FEE(CASH OR HECK 071 REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Af DATE <br /> T <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CityUnit 1 <br /> 1. b , <br /> 2, Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. 1-7 <br /> ni 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> ,PrOTHER CLEANUP SITE(NON-LOP) AT FOOD FACILITY ❑WASTE TIRE <br /> (UNDERGROUND TANK(MONITORING/REMOVAL) M DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 13 MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> El TATTOO/BODY PIERCING 0 POOLISPA LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 48-06 9/14/2006 <br />