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Lzi Lbizuua 1t: 1U IAA @J 001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, 38 Web; 3029 //h/f� 2 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgovRllq� 6? J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> !!!11777 <br /> ren 7 / <br /> L JIPP�CArjT rYo �1r BUSINESSIAGENCY:✓rn./(rr A,�✓C+ P <br /> ADDRESS SD F mo { S 2o'�F/oo� chy/staterzlp Son rranc-scafCA 9ytas <br /> PHONE(1): _(WJJ S9/-7572 PHONE(2): (Y/S)SY/-7500 FACSIMILE: rylS)5-9/ -7S/Q <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of applicatlon submittal-Tentative only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS E14D USE ONLY <br /> SheetA Stree <br /> /t Name city <br /> 1. DOO WeS� CAGrCh VrYe{ SfD GE{an '� �E ❑ Unit <br /> 2. <br /> ❑ Unit 2 <br /> 3. <br /> 4' Unit 3 <br /> 5. Q <br /> 0. Unita <br /> 7. <br /> 8. ❑ Unit5 1� <br /> 9. <br /> 10. ❑ Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYAlEHICLE <br /> P+s <br /> ��,,..yyOTHER CLEANUP SITE(NON ❑WASTE TIRE <br /> -LOP) ❑FOOD FACILITY lM'I <br /> LUNDERGROUNO TANK(MONITORING/REMOVAL) ❑DOG KENNEL 17 DAIRY n <br /> '_.FIAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH O WASTEWATER TREATMENT PLANT 1121p <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCIt/YARDICNEM TOILETS <br /> 13 MEDICAL WAsoDy PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASIE FACILITY r3 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 5:00 AMS:00PM -EYCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by chocking the appropriate <br /> box(es). At(east one file type MUST be selected. Fm to(20914ti4.0138 or mail to the address iodicated 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 IT 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 ecpense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> ,9 <br /> EHD dB-0S elDaroB <br /> PUBLIC RECORDS RELEASE APP FORM <br />