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DATE RECEIVED EHD LOG NUMBER <br /> �-- SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT v <br /> ZQ11 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 6�5 <br /> tiTFLHP'tTF� PUBLIC RECORDS RELEASE APPLICATION <br /> APRICANT: C�1"� �`t�'4�-V BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP:_ <br /> PHONE (1): � PHONE (2): FACSIMILE:_ _ <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUET 1 FEE(CASH OR CHECCC LY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ' DATE <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1. ljY tU t 2 `?.5 1 <br /> 2. — — - V Unit 2 <br /> 3. LV <br /> ff <br /> 4. Unit 3 <br /> 5. �. <br /> 6. <br /> -- __ Unit 4 <br /> 7. <br /> $ %7 Anit 5 <br /> 9. <br /> 10. <br /> nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONM NTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIHOTEL PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ®TATTOO/BODY PIERCING 1POOLISPA 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-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 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 $122 deposit prior to review. <br /> EHD USE ONLY <br /> 4- L A,,d <br /> EHD 48-06 -- <br /> n�r�nrn <br />