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DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www•sjgov.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: "t �J (fl BUSINESS/AGENCY: j � Yse �r <br /> ADDRESS: �/��� G fiV SU,r� CITY/STATEIZIP: .5iWA! e- r r <br /> PHONE(1): �f/�, ��i ��C PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of app' tion submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUES -$12 E S R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN DY(S <br /> DATE <br /> SIGNATURE OF APPLICANT mss'//ss <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS 7USENLY <br /> Street# Street Name City ❑Unit 1 <br /> [22. <br /> ❑Unit 2- <br /> 3.4. —T <br /> nit 3 <br /> 5. 1 �� (�I�c la�x <br /> 6. J nit 4 <br /> 7) <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 9. 0 Unit 6 <br /> Specific Date Range of Infonrnation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) F1 HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) F1 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) F]DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> I. 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$125 deposit prior to review. <br /> F34D USE.ONLY <br /> 8/1111 <br /> EHD 48-06 <br />