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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �) � tiGETelephone, (209) 468-3420 Fax: (209)464-0138 Web: www-sjg0V.o <br /> K7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AP,LI�AN7: BUSINESSIAGENCY: <br /> ADDRESS: p ;7) �/ <br /> PHONE(1): 7 PHONE(2): -7 FACSIMILE; �UJT� 6 _6 <br /> TENTATIVE"APPOINTMENT DATE; �G- �0� Tlma: <br /> (Please allow ten business days from date of Qpplic&tion submittal-•Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHE K ONLY)-REQUEST PROCESSED IN THREE91NE55 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City / <br /> 1. 2F .S'�7`7r � t4 ❑Unit1 <br /> �� <br /> ❑Unit Z <br /> 3. <br /> 4. l <br /> 5 Unit 3 <br /> 6. <br /> 7. 4 <br /> 8. <br /> ❑Unit 5 <br /> 1U. ❑ Unit <br /> Specific Date Range of Information Requested: From to <br /> OnFREENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(U3T)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORIN6IREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> D <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TA'TTOoIBoDY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 4DICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00aM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addressee In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-013 o mail to th a ove addr s. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <br /> days after receipt of application. The tiles 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 the EHD staff may not be immediately available for review. A new application <br /> may be 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 expanse Of the applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> PEHD USE ONLY <br /> EHD 4MS 1 :W.07 <br /> PUBLIC RECORD RELEASE APP F RM <br />