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Apr 01 11 04: 48p P. 1 <br /> to 0 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEjr A <br /> NT <br /> ' 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)-1168-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC (RECORDS RELEASE APPLICATION <br /> 0 - ((\\ <br /> pp F0 BUSINESS/AGENCY:JL����F\ a��i (lG <br /> ADD ESS: ZL, (�\v�' \1S :jam F.: _�_ \ CITY/STATE/ZIP: lC Ci`C; I 'j " ` <br /> PHONE(1): .90S )3y ADIl160 _ PHONE(2): q a 5_q 2-'SO _ 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 EXPEDITER UEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTl� �,(�,U DATE <br /> Electronic Information: ❑List❑ Map–Description: <br /> FILE ADCIRESS EHD USE ONLY <br /> Street#– Street Name City _ nit a <br /> 2. --- –– -- -- ❑Unit 2 <br /> 3. <br /> 4. -- - --- ----- – -- —_---- EAnit 3 <br /> 5. <br /> s. I <br /> –��_ _�. – -- - -- -- --- - 0Unit4 <br /> 7. <br /> ❑Unit 5 <br /> 9. <br /> E Unit 6 <br /> Specific Date Range of Information Requested: From A i 1 M6 to pF p j.i'f� rt1 <br /> ENVIRONMENTAL HIEALTH DEPARTMENT PILES �Ie c �ny <br /> UNDERGROUND TANK(US r)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE I� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE ,\ –'\ <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATO} ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT I \� <br /> TIERED PERMITTED FACILI'Y ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS vl <br /> ❑TATTOOIBODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILIT) ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(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 on>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 returnee 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 applicaint may require a$122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 <br /> 07/28/10 <br />