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;916-786-2434 # 1/ 1 II JU L/ SAN JOAQUIN COUNTY EHD LOG NUMBER 2010 ENVIRONMENTAL HEALTH DEPARTMENT JUN 0 1 600 East Main St. Stockton, CA 95202-3029 ENVIRONMENT HEAdNephone: (209) 468-3420 Fax: (209) 464-0138 Web: WWW.sjgov.org1e 31 PEWITISERVICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT. BUSINESSIAGENCY:� ADDRESS: Y CITY/STATE/ZIP: P��y i� L S 6 7(5 PHONE (1):r�� ' '��J �' � PH NE (2): Oy-)FACSIMILE: TENTATIVE' APPOINTMENT DATE: („ I (S f Time: (Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST $115 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANTDATE �g l % ( O Electronic Information: ❑ List ❑ Map — Description: FILE ADDRESS Street # Street Name City EHD USE ONLY [I unit 1 ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT [SOLID WASTE FACILITYIVEHICLE OTHER CLEANUP SITE (NON -LOP) ❑ Unit 2 2. �C r _ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL 3. HAZARDOUS WASTE GENERATORC/— ❑ CHICKEN RANCH _ nit 3 4. ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS 5 ❑ POOLISPA ❑ LAND USE APPLICATION SITES 4 s' -- —atoW,t 7. ❑ Unit 5 B. 9.10. — nit 6 Specific Date Range of Information Requested: From to i ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT [SOLID WASTE FACILITYIVEHICLE OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE �C r _ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATORC/— ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. Address ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $115 deposit prior to review. 5. If you need further assistance, please contact Diane Martinez, at (209) 468-3425.