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DATR EiCEIVED • SAN JOAQUIN COUNTY F � <br /> MAR 12 2012 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> ENVIRONMENTAL HE4LTH <br /> Rush <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ♦ J /V LL- BUSINESS/AGENCY: <br /> ADDRESS: CITYISTATE/ZIP: <br /> PHONE (1): d P ONE(2): �V7a FACSIMILE: l <br /> TE TA T1 E" N NT DATE: Time: <br /> �,/ (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> J4 CHECK BOX TO EXPEDITE REQUEST-$1 H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLI DAT e � <br /> Electronic Inforrnatio . List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Str t# Street Name City <br /> — ❑Unit 1 <br /> 4. l� / <br /> Unit3 I� <br /> 6. <br /> unit4 <br /> 8: <br /> 9. _. ❑Unit 5 <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'J t NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE d-b � <br /> )OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> rr--�UNDERGROUND TANK(MONITORINGIREMOVAL]� El DOG KENNEL ❑ 4 <br /> DAIRY z <br /> �C AZARDOUS WASTE GENERAT0CY, ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANTS-/ <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ElTATTOOIBODY PIERCING ❑PUMP ERTRUCKIARAL TOILETS <br /> ❑POOIJSPA El LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(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 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 be <br /> submitted when the file is available. <br /> 4. Any Nle 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$125 deposit prior to review. <br /> s 7 t/ <br /> z <br /> EHD4a- e <br /> 9/1/11 <br />