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Df�Fk, Iv p EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> JAN 2 L01a ENVIRONMENTAL. HEALTH DEPARTMENT j <br /> 600 East Main S#. Stockton, CA 95202-2708 X5 <br /> ENI NIRONN;: � one: (209) 468-3420 Fax: (209) 464-0138 Web: wWW.sjgov.orglehd <br /> F�ERC4tt1T/SERVI��� <br /> PUBLIC RECORD RELEASE APPLICATION <br /> APPLICANT: l BUSINESS/AGENCY:_ gk1 <br /> Cj�y� <br /> ADDRESS: �` / <br /> _Y��f �GI�N� /�[/e -__ CITYISTATEIZIP: C g.5-z U <br /> PHONE (i): <br /> �/j�—cf//r y 7 7f PHONE (2): 20oar yes 2. FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> -P(CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH OR Elf LY)- EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLIC DATE / —Z �� / o <br /> Electronic Information: ❑ List ❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. .0-unit-2- <br /> 3. <br /> 4. <br /> ro <br /> 5. i P <br /> 6. <br /> y nit 4 <br /> 7. <br /> L10 <br /> . <br /> Specific Date Range of Information Requested: from to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) [-IFOODFACILITY L❑SOLID WASTE FACILITYNEHICLE <br /> MONITORINGIREMOVAL ❑WASTE TIRE <br /> fA UNDERGROUND TANK <br /> ( ) ❑Doc KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑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:OOPM(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 /> , <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 $115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance Please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> cion RIA - <br />