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DATE RECEIVED r <br /> *No, SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> C1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov. e <br /> 327t <br /> PUBLIC RECORDS RELEASE APPLICATI N <br /> APPLICANT: 1 (� S <br /> BUSINES AGENC -p— <br /> ADDRESS: <br /> F ICI <br /> PHONE(1):_��i ! PHONE(2): 4 9 <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: '/ Q <br /> (Please allow 10 business days from date of application submittal-'Tentative onlTime- <br /> CHECK BOX TO EXPEDITE R T .00 FEE AS ECK ONLY)-REQUEST PROCESSED IN 3 B SINESS PAYS <br /> SIGNATURE OF APPLICANT <br /> DATE v <br /> Electronic Information: ❑List-E]Map—Description: <br /> FILE ADDRESS EHD USEONLY <br /> Street# 1 Street Name City <br /> 1' '�C•,� 1\ - C'i c� 0 Unit 1 <br /> Cry <br /> 2. <br /> ❑ Unit 2 <br /> 3. <br /> 4' � Unit 3 <br /> 5. <br /> �\ <br /> s. �•`"���°� Unit 4 <br /> c <br /> 7. ti <br /> 8• ❑ Unit 6 <br /> 9. ` <br /> 10. ❑ Unit 6 <br /> L <br /> Specific Date Range of Information Requested: From to <br /> U/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 HOUSING ABATEMENT E3 SOLID WASTE FACILITY/VEHICLE <br /> �THER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL 13 DAIRY <br /> O HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTELIHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑POOL/SPA O LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM•B:OOPM -EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the We(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 EHO 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 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 /> 4-Ar <br /> EHD48.OBWEB 882007 <br />