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r ����/� +� a EHD LOG NUMBER <br /> 1 <br /> ON+li 11 `�U1 �"'� SAN JOAQUIN COUNTY `Of <br /> L -, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> EfdVIRLIif��;Ef';i s int�T�Ifephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd A%7 <br /> PER siT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: •.' BUSINESS/AGENCY: /1Z'4 <br /> !� <br /> ADDRESS: �� � t[I> City/State/Zip <br /> PHONEPHONE(2): > FACSIMILE:` . 6rs. <br /> TENTATIVE*APPOINTMENT DATE::i:,,:a �/ .. Time: C✓ f, vl <br /> (Please allow 10 business days from'date of a6plicatioK submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU $105 FEE(Cr CHECK,ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE A <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> /o29JciL ❑ Unit <br /> 3- <br /> 7VI r, <br /> Unit 3 <br /> 4. 1 36 3aUL's <br /> 5. zfc- et2�reml 77 <br /> 6. 7G! rf(vt� elf �� 41P r-1 /✓ <br /> 7 ❑ Unit <br /> 9. ? 21 lr1V'1` ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested From to <br /> ENVIRONMENTAL HEALTH EPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> I UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL I] DAIRY <br /> WHAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 13 MOTELIHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING E3 POOLISPA ❑ LAND USE APPLICATION SITES <br /> O 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> tia€> <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />