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DATE RECEIVED EHD LO"UMIBER <br /> SAN JOAQUIN COUNTY .� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or q/573 <br /> j PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ' /1(L''U' G(�� BUSINESS/AGENC <br /> ADDRESS:_ l S �.t'�u I S t Z uCITY/STATE/ZIP O2/C <br /> PHONE(1): .2 Z 2 100 PHONE(2): <br /> FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD_USE ONLY <br /> Street# Street Name 1 City ❑ Unit 1 <br /> 1. <br /> 2• 70 , to'l-5 n'i- (.-0 t / ❑ Unit <br /> 5. <br /> G Unit 4 <br /> 7. <br /> 8. Unit 5 <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J JJNDERGROUND TANK(UST)CLEANUP SITE(LOP), 13 HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) �n CIFOOD FACILITY 11 WASTE TIRE <br /> G/ <br /> UNDERGROUND TANK(MONITORINREMOVAL) 173DOG KENNEL C3DAIRY <br /> .ff HAZARDOUS WASTE GENERATOR 1 \4 ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ( ❑ POOL/SPALAND US APP,yLICATION ITES <br /> ❑MEDICAL WASTE FACILITY v ❑ OTHER(PLEASE SPECIFY)'� y � I pfCq/ ,cS <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - 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$105.00 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 4"6 <br />