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1 - <br /> DATE RECEIVED EHD LOG NUMBER <br /> .�, SAN JOAQUIN COUNTY �.t+ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 9 , BUSINESS/AGENCY: (Pro ( � r l� c <br /> ADDRESS: ct C ,- Lf-(COO S,3 ,L L ( ry CA 131 <br /> /4� 6 <br /> PHONE(1): PHONE(2): FACSIMILE:CDDCP 0( -3l U <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 RE EST- 95.00 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1 3/ 6 -7 <br /> Electronic Information: Z List ❑ Map—Description: A)FA ZZ r -125w ?-,rk /,�i a <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. 4 Do /L: tiw-+ 1 Lod il <br /> 2. ❑ Unit 2 <br /> 3. <br /> ❑ <br /> 4. Unit 3 <br /> 5. ❑ Unit 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑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 /> 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> !v ; � <br /> EHD 48-06 9/13/2006 <br />