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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 ovcj 0 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ./ <br /> f� PnUBLIC RECORDS RELEASE APPLICATION y ^ / <br /> APPLICANT: /� !L?�1 /C 0 G �� L'1 / BUSINESS/AGENCY: ( il Cit !r(/L'l <br /> Gf S C _T_-----_..__.__ <br /> ADDRESS: /JUy LtCITY/STATE(ZIP 6y0E L 66 ,60 <br /> PHONE(1): ! j I �� t- Ll d- Ck) PHONE(2)K ' 7 <br /> .J C% 'S Ct�� /� FACSIMILE: Cil 2- <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 REQU T,-$105.00 FEE(C R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SI NATURE OF APPLICANT ' DATE U <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> I. /qO <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9' _ `a El 6 <br /> 10. <br /> Specific Date Range of Information Requested: From Cl 9 C' to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 3�l�s lD✓ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE �/ I <br /> fi(IPTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13 WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> :tAZARDOUS WASTE GENERATOfC4 ❑ CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITYi* ❑ MOTEL/HOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY IJ 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 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 /> 104 F, I I u5 l <br /> I.......... a and nnna <br />