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VA, EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />Dc ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Tale e:209 468-3420 Fax: 209 464-0138 Web: www.sjgov.org/ehd <br />I I°( <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:. �� , BUSINESS/AGENCY: <br />ADDRESS: /'� �;`9 e-s� �-- ' CITY/STATE/ZIP: 1;; <br />PHONE (1):G( ( PHONE (2): FACSIMILE: CL'�' <br />Please allow 10 business days from date of application submittal for the records to be available. - <br />Staff will contact y6u to arrange /an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST - S1�5"FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />by—Adyti <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS EHD USEONLY <br />Specific Date Range of Information Requested: From 77 EMU to .P <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES i <br />[�I3ERGRS2UNfl 1 AHK_L_-GL-EANUR (LQ�)_ ❑ MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br />L� qt§ I NOWLQR)-- ❑ HOUSING ABATEMENT ❑ WASTE TIRE l 0 °t� � q- r <br />©-113NDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY _ <br />E3*919VRTMK ❑ CHICKEN RANCH/ DOG KENNELI <br />❑WASTEWATER TREATMENT LANT <br />Ej'fl'AZARDOUSWASTE/HAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEMICALTOILETS <br />01iERED-P-crvunr_RILITY ❑POOLISPA <br />��PiERfING� El LAND USE APPLICATION SITES <br />❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. List ui3 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. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. 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 />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 $125 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** <br />Street # <br />Street Name <br />City <br />Unit 1 <br />AD Unit 2 <br />2. <br />Vj ��,� . < <br />; Al je7 i I <br />' <br />I Unit 3 <br />4 <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 77 EMU to .P <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES i <br />[�I3ERGRS2UNfl 1 AHK_L_-GL-EANUR (LQ�)_ ❑ MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br />L� qt§ I NOWLQR)-- ❑ HOUSING ABATEMENT ❑ WASTE TIRE l 0 °t� � q- r <br />©-113NDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY _ <br />E3*919VRTMK ❑ CHICKEN RANCH/ DOG KENNELI <br />❑WASTEWATER TREATMENT LANT <br />Ej'fl'AZARDOUSWASTE/HAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEMICALTOILETS <br />01iERED-P-crvunr_RILITY ❑POOLISPA <br />��PiERfING� El LAND USE APPLICATION SITES <br />❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. List ui3 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. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. 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 />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 $125 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** <br />