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F)'\TE RECEIVED 41 EHD LOG NUMBER <br /> OAQUIN COUNT <br /> AL HEALTH DEPARTMENT <br /> L <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> 3 LT&phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehid <br /> HEALT�IPUBLIC REqORDS RELEASE APPLICATION <br /> P Ek",N1 I �i <br /> APPLICANT:_L__� i )In A/_'�t"j JIr in , BUSINESS/AGENCY: <br /> ADDRESS: c CITY/S ATE/ZIP: <br /> PHONE (1): '5���PHONE (2):_ FACSIMILE: <br /> TENTAT/VE*APPOIN'T �AT,,E'- Time� <br /> (Please allow 10 buMesNsTd f m date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUE 15.00 FEE(CASH OR CHECK OVNL - EQUE PROCIESSEDIN3BU INES;I�DYS <br /> T <br /> SIGNATURE OF APPLICAN DATE <br /> Electronic Information: E]Pst O/Map-Description: <br /> ',EILJE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> El U nit 1, <br /> 2. <br /> El-Unit-2 <br /> 3. <br /> 4. _XU 9 Rt 3 <br /> 5. <br /> 6. <br /> —____,<U nit 4 <br /> ��w Q2 <br /> 7. <br /> 8- El Unit 5 <br /> 9. <br /> 10. El Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> RGRO ND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITY[VEHICLE A <br /> CL <br /> Ri�OTHER EUANUP SITE(NON-LOP) F1 FOOD FACILITY [j WASTE TIRE <br /> UNDER�ROUND TANK(MONITORINGIREMOVAL) F]DOG KENNEL [:1 DAIRY <br /> D-41GARDOUS WASTE GENERATOFP�, CHICKEN RANCH [:]WASTEWATER TREATMENT PLANT <br /> J;T-fRED PERMIT-TED FACILIT)P�,, MOTELMOTEL PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TATTOOIBODY PIERCING POOLISPA 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: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 prn 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 $115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If ou need further assistance please contact Diane Martinez directly (2 <br /> y 09)468-3425. Thank You*** <br /> to' �rov&joa'�5 V 4 <br /> �r �l_'(04,111VI tA XW'30 :17/' 5 14 Jq'�P kO te. <br />