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v r 10/ cvOJ 13:04 t'AA _ [A001 <br />DATE RECEIVE EHD I r)r, NI MARFR <br />r'_1 � =-n SAN JOAQUIN COUNTY <br />�� ENVIRONMENTAL HEALTH DEPARTMENT <br />1L 1 7 2009 600 East Main Street, Stockton, CA 95202-3029 <br />;0 w Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org Lfsoo <br />ENV:!P,0t'N1Ei�l_ HEAILTH <br />^; PUBLIC RECORDS RELEASE APPLICATION <br />PHONE (1): <br />(o fa I - 4,.8'7 PHONE ae(2): !jlq- 394 -2?Db FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: f"2-7" ® Q Time: o r& <br />(Please allow 10 business days from date of application submittal -*Tentative only - must be onfirmed) <br />CHECK SOX TO EXPEDITE REQUEST - $105 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 7-110-14 <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From 1�C � dot to p r <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES qx/-'/_e�I f r <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br />�r JJ/l <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE {7 / t <br />UNDERGROU T MO G!R A/ ❑ ❑ t <br />ND ANK ( NITORIN EMOVAL) DOG KENNEL DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />- /- <br />TIERED PERMITTED FACILITY(I ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br />O TATTOOIBODY PIERCING 13 PGOUSPA ❑ 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-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 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 $105 deposit prior to review. <br />EHD USE ONLY <br />�• - v I N <br />EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />