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DATE RECEIVED <br />MR)", <br />ECIR <br />� WE[0 SAN JOAQUIN COUNTY f EHD LUG NUMBER <br />LiJ <br />ENV xONMENTAL HEALTH DEPARTMENT <br />tLU v 1 9 2007 600 East Main Street, Stockton, CA 95202-2708 <br />Telelihone: (209) 468-3420 Tax: (209) 464-0138 Web: www.sjgov.or e} <br />ENVIFi01WENT HEALTH <br />o Ve <br />PFRFAT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: efp:r <br />BUSINESSIAGENCY: <br />ADDRESS: <br />PHONE (1):I <br />PHONE (2): <br />FA I I E: <br />Ab�� 2Z <br />TENTATIVE* APPOINTMENT DATE: 111111F %F a W_ <br />(Please allow 10 business days from date of application submittal -'Tentative onl Time: <br />y -must be confirmed) <br />CHECK BOX TO EXPEDITE REQUEST - $98.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />ZG <br />Specific Date Range of Information <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />'HAZARDOUS WASTE GENERATOR <br />© TIERED PERMITTED FACILITY <br />TATTOOI$ODY PIERCING <br />Cl MEDICAL WASTE FACILITY <br />M HOUSING ABATEMENT <br />C3 FOOIZ FACILITY <br />❑ DOG KENNEL <br />❑ CHICKEN RANCH <br />C3 MOTELIHOTEL <br />El POOLISPA <br />13 OTHER (PLEASE SPECT <br />❑ SOLID WASTE FACILITYIVEHICLE <br />0 WASTE TIRE <br />13 DAIRY <br />❑ WASTEWATER TREATMENT PLANT <br />0 PUMPER TRUCKIYARDICHEM TOILETS <br />LAND USE APPLICATION SITES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - 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 behold 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 $98.00 deposit prior to review. <br />EHD USE ONLY <br />*** I¢ you should need further assistance please contact Diane Martinez E? (209)468-3425 directly. Thank You*** <br />