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SAN JOAQUIN COUNTY <br /> ENVk. NTAL HEALTH DEPARTNIr . <br /> 304 East Weber Avenue, aid Floor,Stbekton, CA 95202-2708' <br /> 7 elephone: (209}468-3424 Fax: (209)'464-0138 Web: www.sigov.org/elid0507 <br /> PUBLIC RECORDS RELEASEAPPLICATION <br /> ,APPLICANT: BUSINESSIAGENCY: <br /> .ADDRESS. b D <br /> PHONE(1): D PHONE(2): 1 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) i <br /> 0 CHECK BOX TO EXPEDITE REAVES - .00 FEE(CASH Oft CHECK ONLY)-rREQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> Z. ❑ Unit 2 <br /> 3. <br /> .4. Unit 3 <br /> 5. . <br /> c �Uni 4 a <br /> 4k <br /> 7. rY _ w <br /> w. Unit 5 <br /> ❑ Unit 6 <br /> 10: <br /> Specific Date Range of Information.Requested.From to <br /> ENVIRONMENTAL:HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 'HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE <br /> NDEItGROUNb TANK(MONtToRiNGIREMOVAL) ❑ DOG KENNEL - ❑ DAIRY <br /> 4ZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMnTED'FACILITY ❑MOTELIHOTEL ❑PuMYER TRUCKIYARDICHEM 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 0:00 AM-5:00pm - EXCLUDING HOLIDAYS. <br /> 7. 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)4_6.4-0138 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 r <br /> p 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 bNLY <br /> Elio 4"6 W132006 <br />