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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> X11 E=R ENAONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202 <br /> M Y 2 5 2007 Telephone: (209)468-3420 Fax: (209)464-0138 Web: WWW.sjgov.org/ehd <br /> c U1T,.lEiJ i HEACfH PUBLIC RECORDS RELEASE APPLICATION <br /> —ice ip; <br /> APPLICANT �%. 0� � <br /> BUSINESS/AGENCY: <br /> ADDRESS: .. <br /> PHONE(1)c i` Y�� wf Z / PHONE(2): <br /> `/' FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only•must be confirmed) <br /> El <br /> CHECK BOX TO EXPEDITE REQUES5.00 E(CASH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT c'/�% C� DATE S Z -©7 <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS EH USE ONLY <br /> Street Name <br /> Street# St <br /> City <br /> LDNW (2 Unit <br /> 2. <br /> 3. Unit 2 <br /> 4' /Unit 3 <br /> 5. <br /> s• Unit 4 <br /> 7. <br /> 8. Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From r 2-K - /94 7 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES , <br /> �UIJDERGROUND TANK(UST)CLEANUP SITE LOP <br /> ENVIRONMENTAL <br /> ( ) I USING ABATEMENT ❑ FOLIO WASTE FACILITYNEHICLE <br /> �THER CLEANUP SITE(NON-LOP) IpOD FACILITY gSTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) Q' G KENNEL ❑ DAIRY <br /> �ARDOUS WASTE GENERATOR MtHICKEN RANCH ❑WASTEWATER TREATMENT <br /> PLANT <br /> 4XJERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCK/YARD/CHEM TOILETS <br /> 700/BODY PIERCING ❑ POOLJSPA 10 LAND USE APPLICATION SITES <br /> EDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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. Faxto(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 beo"*"* <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 a <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. cant. <br /> EHD USE ONLY <br /> 1 en <br /> EHD 4846 916/200] <br />