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t Wli tt <br /> DATE RECEivED SAN JOAQUIN COUNTY <br /> V <br /> ENviRoNmENTAL HEALTH DEPARTMENT <br /> P 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov-org/e <br /> 05 APR I <br /> PUBLIC RECORDS RELEASE APPLICATION - <br /> APPLICANT: � -� n <br /> BUSINESSlAGENCY: - ,0 T Y <br /> TENTATIVE*APPOINTMENT DATE: Time: ' - '11 Lu�;l <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirm <br /> ❑ CHECK BOX TO EXPEDITE REQQEST-$93.00 F ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1Q /1C CIJ, DATE <br /> UNrr DISTRIBUTION 0 Unit i D Unit 2 ❑Unit 3 O Unit 4 0 Unit 5 13 Unit 6 ❑ Other(electronictlistsimaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street/ Street Name City <br /> r2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. -- <br /> 9. <br /> �a. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IX UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WAsTE FACILITYMMUCLE <br /> 0 OTHER CLEANUP SITE(NON4­OP) 0 FOOD FACILITY 0 WASTE TIRE <br /> 0 UNDERGROUND TANK(MON TORINGJREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 1I HAZARDous WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK(YARDlCHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 7. List up to ten addresses in the space above. Select the types)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files wail be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application 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 expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 49-02.006 <br /> 15123104 <br /> � °d <br />