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DA EHD LOG NUMBER <br />1:t;L1VLU SAN JOAQUIN COUNTY <br />ENOONMENTAL HEALTH DEPART NT <br />APR 2 2 2008 600 East Main Street, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL 3 <br />HEALTH DEPARTMEN-PUBLIC RECORDS RELEASE APPLICATION J <br />APPLICANT: In BUSINESS/AGENCY: Lo V-' O F I <br />ADDRESS: <br />PHONE (1): -� & 1 J' 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 />13 CHECK BOX TO EXPEDITE REQUEST - $98.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />Fa_ <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # <br />Street Name <br />City <br />❑ Unit 1 <br />1. <br />2. <br />0 <br />i� <br />Unit 2 <br />/W 7 -.t_ <br />3. <br />Unit 3 <br />4 <br />C_1 <br />5. <br />❑ Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />13 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br />0 OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />AUNDERGROUND TANK (MONITORING/REMOVAL) C] DOG KENNEL 0 DAIRY <br />HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br />11 TIERED PERMITTED FACILITY 13 MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />13 TATTOO/BODY PIERCING 0 POOL/SPA ❑ LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY ❑ 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 END staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $98.00 deposit prior to review. <br />EHD USE ONLY <br />*** If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br />- 1163 1 <br />EHD 48.06 9/14/2006 <br />