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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTII ENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE: FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> In CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> i. Street aty ❑ Unit 1 <br /> 2. Street d <br /> ty <br /> 3. Street city ❑ Unit 2 <br /> 4. Street city <br /> S. Street city ❑ Unit 3 <br /> 8. street O <br /> 7. Street ci ❑ Unit 4 <br /> L108. Street Ci <br /> ty <br /> 9. Street city ❑ Unit 5 <br /> . Street <br /> ENVIRONMENTAL HEALTH D PARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select he type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days atter receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. . j <br /> 3. A file that is actively being worked on by EHD staff r iay not be immediately available for review. A new <br /> application may be submitted when the file is availa le. <br /> 4. Any file not returned in the same condition as relea ed will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same ap licant may require a$93.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be confirmedwith EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE :, TIME `_. . <br /> DATE CONFIRMED PHONE FAX : :INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ER)48-02006 - <br /> 8/8/2003 - , <br />