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DATE RECEIVED • • EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow ten business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> 1. <br /> 2. <br /> 71 Unit 2 <br /> 3. <br /> 4. O Unit 3 <br /> 5. <br /> 6, 0 Unit <br /> 7. <br /> 8, O Unit 5 <br /> 9. <br /> ❑Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT El SOLID WASTE FACILITYNEHICLE <br /> 173 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 73 WASTE TIRE <br /> 11 UNDERGROUND TANK(MONITORING/REMOVAL) [71 DOG KENNEL 1:1 DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> 73 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> CI TATTOO/BODY PIERCING 13 POOUSPA 0 LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY C]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-$:DOPM - 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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 the EHD staff may not be immediately available for review. A new application <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 10/19)07 - PUBLIC RECORDS RELEASE APP FORM <br />