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D eEl � SAN JOA UIN COUNTY EHD LOG NUMBER <br /> 1 ENVIRONMENTAL HEALTH DEPARTMENT 0 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tj one: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/chd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,s /( ,._ s�� SUSINESSIAGENCY: <br /> ADDRESS: CITYISTATEIZIP:_ <br /> PHONE(1):�Q - 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 REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSEDJN•3-B US I NESS DAYS <br /> SIGNATURE OF APPLI ✓DATE / <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City EfUnit 1 <br /> 2. d Unit 2 <br /> 3. J7 <br /> 4. -.(; ��j [71 Unit 3 <br /> 6. q- 5v 9junit4 <br /> 7. !✓ <br /> g• CIL ��� Unit <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From 5./y to 7[7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> E]UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY EISOLID WASTE FACILITY[VEHiCLE <br /> [D OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT U WASTE TIRE <br /> [�]UNDERGROUND TANK(MONITORINGIREMOVAL) []FOOD FACILITY )❑DAIRY <br /> Q ABOVEGROUND TANK CHICKEN RANCH[DDG KENNEL i❑WASTEWATER TREATMENT PLANT <br /> nI HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTELIHOTEL �❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> []TIERED PERMITTED FACILITY 0 POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOI13ODY PIERCING C]COMPLAINTIRESPONSE RECORDS ❑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 u 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 EHO 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[THD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review, `**BOXED AREA-EHD USE ONLY' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 49-06 91402 <br />