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5-22-0P d:30Abr,l:IEinfel CEr MOC ES tc ,2095753444 <br /> -DATE REC r�--N EHD LOG UMBER <br /> ,/1�,L) SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> g '4 2 2 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e d� <br /> E1\1V1R±YNMELNT NcALTH <br /> PER'r0,�Tl'C'0,V1ICFJBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � `J-1(C a BUSINESS/AGENCY: <br /> ADDRESS: Qa b� <br /> PHONE(1): PHONE(2): FACSIMILE: 75—V�1' <br /> TENTATIVE"APPOINTMENT D TE: Time: <br /> (Please allow ten business da from date of application submittal-`Tentative only.must be confirmed) <br /> C3CHECK BOX TO EXPEDITE REQUEST-$�8OLEE(CH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street C Street Name City \\ Unit 1 <br /> 2. <br /> 3. 00Gnit 2 <br /> 4. <br /> 5 nit 3 <br /> 6. <br /> 7. <br /> 8. <br /> Unit s <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> �/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> An UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑ <br /> WASTE TIRE <br /> Ja'QNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL ED DAIRY <br /> [AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> n l <br /> . IERED PERMITTED FACILITY 13MOTELIHOTEL 7�uMPER TRUCKIYARD/CHEM TOILETS <br /> ClTATTOO/BODY PIERCING 13POOLISPA 2 LANG USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ElOTHER(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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 prn will <br /> 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 <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointmen <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by the EHD staff may not be immediately available for review. A new applicati n <br /> may be submitted when the file is available. <br /> 4. Any filenot returned in the same condition as released will be reorganized by EHD staff at the expense of the applic nt. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4046 10129107 <br /> PUBLIC RECORDb RELEASE j PP FORM <br />