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VfIIC f\CVCIYCV /L <br /> 0 SAN JOAQUIN COUNTY • --" 1/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 Fast Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 o /� <br /> I Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd v <br /> ?0.3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ` I BUSINESSIAGENCY: <br /> ADDRESS:�`� // C t� l Vlc� < « �� i c J <br /> PHONE(t):2O Zz �� (� PHONE(2):_ y_0 Z— 6�-2 —Z2, FACSIMILE: D�fj A •Com <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•rentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU -$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �1 G — DATE <br /> I1NIT DISTPJ BUTK u ()nit 1 ❑ Unit nit 3 Unit 4 ❑ Unit 6 _CT Unit 6 ❑ Other(electroniCAisWmaps) <br /> FILE ADDRESS <br /> Street Street Name City EHD USE ONLY <br /> 2. <br /> 3. ,f <br /> 4. <br /> G. <br /> 8. <br /> a� r <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILMIVEHICLE <br /> . THER CLEANUP SITE(NCN-LOP) FACILITY ❑WASTE TIRE. <br /> UNDERGROUND TANK(MOMTOR(NGAIEMOYAL) ❑ KENNEL 0 DAIRY <br /> IkRAZARDOUWASTE GENERATOR CHICKEN RANCH 13WASTEWATERTREATMENT PLANT <br /> ❑TIERED PER ❑ <br /> MfTTED FACILITY ❑MTEUHOTEL - ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING -❑POOLISPA ❑LAND USE APPLICATm SHES <br /> ❑MEDICAL WASTE FACILITY - ❑OTHER(PLEASE SPECIE'!) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRiDAr 6:0o AM-6:00PM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address <br /> indicated above. Address ranges will not be accepted–for additional assistance with file addresses,contact <br /> the END.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 1�+; <br /> lln�eozuoc <br /> umroa <br />