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D :.P � - 6 7005 FNVRONMENT HEALTH PERV111T/SERVIOES ADDRESS: Z I p EHD LOG NUMBER fe SAN JOAQUIN COUNTY ENYIRONMENTALHEALTH DEPARTM IR" or 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 /r/� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd, 9 RECORDS RELEASE APPLICATION IJ PHONE(1): ,-,/ZS 066 6000-_PHONE(2): TENTATIVE" APPOINTMENT DATE: (Please allow 10 business days from date of application 01 CHECK BOX TO EXPEDITE REQUEST - $FEE (CASH OR CHECK ONLY) SIGNATURE OF APPLICANT A -l' Time: RE _ w wrouve only - mustbe confirm �1FPV�. REQUEST PROCESSED IN 3 WN A"!� DATE 5 UNITOISTRIUUTION E2 Unit 1 0Unit x jrUnit3 OUnit 4 0Unit 5 0 Unit6 t7 Other(elactroniUlistS1,MP3 ❑HazArtDWS WASTE GENERATOR • TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TROCKlYARDICHEM TOILETS 0 LAND USE APPLICATION $RES J SUDet>r FILE ADDRESS Street Name EHD USE ONLY city .-- 1. 1, List up to ten addresses in the space above. Select the types) 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 dditionassistance with file addresses, contact indicated above. Address ranges will not be accepted —for aal 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 flies will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. n 6. E9.4. 7. 8. application may be submitted when the file is available. - 10 - applicant Future file reviews by the same applicant may require a $93.00 deposit prior to review. Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES ter. 1 111111111h.- ZeUNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACIDTYNEHICLE r 0 FOOD FACILITY 0 WASTE TIRE 0 OTHER CLEANUP SITE (NON -LOP) ., UNDERGROUND TANK (MONITORING)REs10VAL) V DOG KENNEL 0 DAIRY 0CHICKEN RANCH M WASTEWATER TREATMENT PLANT ❑HazArtDWS WASTE GENERATOR • TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TROCKlYARDICHEM TOILETS 0 LAND USE APPLICATION $RES O TAT7001BODY PIERCING ❑ POOLISPA O MEDICAL WASTE FACILITY 0 OTHER(PLEASK$PECIFY) - 1 WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 11:00 AM-5:OOPN - EXCLUDING HOLIDAYS• 1, List up to ten addresses in the space above. Select the types) 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 dditionassistance with file addresses, contact indicated above. Address ranges will not be accepted —for aal 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 flies 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 $93.00 deposit prior to review. EHD 48-024I06 111"6 TOTAL P.O: