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DATE RECEIVED �_ EHD LOG NUMBER <br /> 'ENVIRONMENTAL HEALTH D P' RTM! <br /> A E"NT <br /> MV 2004 600 East Main St. Stockton, CA 95202-2708 <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov. <br /> ENIIRONWNT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a ����� BUSINESSIAGENCY: <br /> rnJ f <br /> ADDRESS: 0 � G/ G�� IiCSJ !.( CITYISTATEIZIP: 5To&lc�_'rU7v (�4 <br /> PHONE (1): t4oY- 6Q — 666 PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENTDATE: a Time: <br /> (Please allow 70 business days from date of application submittal-'Tentative only--must be confirmed) <br /> :A <br /> CHECK <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH OR ECK ONLY)'-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑ List❑ Map—Description: �f <br /> FILE ADDRESS EHD USE ONLY <br /> ' Street# Street Name city <br /> ❑Unit 1 <br /> 2. <br /> ❑Unit 2 <br /> 3. <br /> 4. <br /> nit 3 <br /> 5. <br /> 6. ��Ynit <br /> 7. <br /> ' 8' ❑Unit 5 <br /> i <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From It to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITYd ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHE:MICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA. ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> t <br /> i WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1 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(2 9)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted--for additional assistance with file addresses,contact the END. 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 /> i 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 /> s 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 $115.00 deposit prior to review. <br /> EHD USE ONLY - - <br /> ***If you need further assistance please contact Diane Martinez directs @ (209)468-3425. Thank You*** <br /> FHA dA.l1f. �R .. <br /> AI'J��l1/0 J <br />