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I I/Zt)/ZQQU IJ:5f FAX <br />DATE RECEIVED <br />C7 <br />[A 001/001 <br />SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e 3dqk <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: y� (� BUSINESSIAGENCY: _117-_r rr Y1 'Sp - j 'C <br />ADDRESS: <br />13W,_ clty/statgrzlp 42 <br />PHONE (1): PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: 71me: _I I t �1 <br />(Please allow 10 business days from data of application submittal - *Tenta9ve only - must be confirMed) <br />® CHECK BOX TO EXPEDITE RE T - 5 FEE (CASH Olt C ECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS AYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List C] Map — Description: <br />Specific Date Range of Information Requested: From <br />LE <br />Unit 6 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES 10 �I(e �r <br />UNDERGRoumo TANK (UST} CLEANUP SITE (LOP) HOU AaATEMENT SoLm WASTE FACILITYIVEHICLE <br />OTHER CLEANUP STYE (Noll -LOP) FOOD FACILIN WASTE TIRE / <br />UNDERGROUND TANK (MONITORINWREMOVAL) D( DOG KENNEL DAIRY Woof <br />HAZ,IIRDOUS WASTE t3ENERATOR� CHICKEN RANCH WASTEWATER TReATMENT PLANT <br />TIERED PERMITTED FACILITY m0- MOTELIHOT9L Eem <br />UMPER TRUCK/YARD/CHEM ToILETs <br />TATTORiBODY PIERCING OOLISPA D USE APPLICATION SITES <br />MEDICAL WASTE FAGILn' F� OTHER (PLEASE SPECIFY)_ AL <br />WELL AND SEPTIC PERMrt RECORDs ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 5:00 AM-0:00PM - 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 flies 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 secordingly. <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 $105 deposit prior to review. <br />EHD USE ONLY <br />EHU 45-06 MUM PUBLIC RECORDS RELEASE APP FORM <br />