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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> 00?3 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org <br /> PUBLIC RECORDS RELEASE APPLICATI <br /> APPLICANT: : 5LBUSINESS/AGENCY- <br /> ADDRESS: <br /> (� � � BUSINESS/AGENCY: <br /> ADDRESS: _ I L I r ������° CITY/STATE/ZIP <br /> PHONE(1): 2 C-;c-1 C' I _ y`r7 Z PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> Please allow 10 business days from date of application submittal-*Tentative only s <br /> ( Y �//P��P� y-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105.00 FEE(vA'jIj, DATE CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ; , I c 7/ <br /> i — � � <br /> i <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ <br /> 1. 3'-'Z (rvuo- A:� ii ' r Unit 1 <br /> � ��I UG 1LLC�-�Ccs o b �'A�i'� <br /> 2 ' (p M")Tl�t� h�UG /'V�G`^i. C� P� � �tyCle✓ Dr(95' ❑ Uni <br /> 3. <br /> 4. Unit 3- <br /> 6 Unit 4 <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 FACILITYIVEHICLE <br /> 13 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> 1 UNDERGROUND TANK(MONITORING/REMOVALQD ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTEGENERATOR9\ ❑CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br /> 1�TIERED PERMITTED FACILITV4, O MOTEL/HOTEL 13PUMPER TRUCK/YARD/CHEM TOILETS <br /> SATTOO/BODY PIERCINGIA ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY l>L_ ❑ 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 un 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 48-06 amnnnna <br />