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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> IENVII*,"NMENTAL HEALTH DEPARTMV-tT <br /> 600 East Main Street, Stockton, CA 95202 <br /> L A qq <br /> �007 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> sjgov.org/ehd <br /> J- <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: B11(c <br /> ADDRESS: 7tt i- Z__- <br /> PHONE(1): -612-1 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 RE7QUES3,-5P95.00 (CASH R -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> E(CASH CHECK ONLY) <br /> SIGNATURE OF APPLICANT DATE 57—O7 <br /> Electronic Information: [j List L] Map—Description: <br /> .FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit I <br /> 3 t5.;2 <br /> 2/-- SC,07-7S hrccl <br /> 2. Unit 2 <br /> 3. <br /> U <br /> —4. <br /> :V,0nit 4 <br /> 6. <br /> 7. <br /> 8. <br /> 9. Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From lFk 7 to <br /> ENVIRONMEN2TA HEALTH DEPARTMENT FILES <br /> 0?�U,NDERGRCIUND TANK(UST)CLEANUP SITE(LOP) �OD <br /> USING ABATEMENT 0 POLID WASTE FACILITYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) FACILITY MVASTE TIRE <br /> &UNDERGROUND TANK(MONITORING/REMOVAL) =KENNEL 0 DAIRY <br /> ;_H=TOO/BODY <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ED PERMITTED FACILITY 13 MOTEL/HOTEL 0 MPER TRUCK/YARD/CHEM TOILETS <br /> PIERCING 0 POOUSPA ��LAND USE APPLICATION SITES <br /> ICAL WASTE FACILITY El 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 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 /> EHD 48-06 5116/2DO7 <br />