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DATE RFCEIVED EHD LOG NUMBER <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 /> 7 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESS/AGENCY4-i'J <br /> ADDRESS: S l S— �. ��L`1 S t Z ' CITY/STATE/ZIP_y2 K(al- C� <br /> PHONE(1): 510 (,Z Z- 2-1 co PHONE(2): 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 City ❑ Unit 1 <br /> 1. <br /> 2. Q( i, (,� �SCNt cot- rcu4,oE5 i NU co(' ❑ Unit 2 <br /> 4. /U - +l rr is ��'� C f USS nk 3 <br /> 5. - t� <br /> 6 POOUnit 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 /> �JJNDERGROUND TANK(UST)CLEANUP SITE(LOP), ❑ HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 0 FOOD FACILITY 0 WASTE TIRE f` i f <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL 0 DAIRY 'V Up l <br /> .�HAZARDOUS WASTE GENERATOR[, ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT I �9 <br /> .0'TIERED PERMITTED FACILITY.,4_ __ \� 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING( (�`� ❑ POOL/SPA 111 LAND US APPLICATION ITES <br /> 0 MEDICAL WASTE FACILITY C)� v 0 OTHER(PLEASE SPECIFY)A k-&ejj�df*' ,c S <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - 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 <br />