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DUE SAN JflA UIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> M] 0 5 ?007 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> ENViR0Nt9Eid T HEALTfTelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERUT/SERVICES PLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: hULb�u 0 Sk+ i wl BUSINESS/AGENCY: <br /> ADDRESS: "(TO ✓, �^ S 3 <br /> PHONE(1): 1 )14 6�b --2`3'l I PHONE(2): FACSIMILE• <br /> h' <br /> TENTATIVE*APPOINTMENT DATE: Time: OQ� <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE 1 0 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑ Unit 1 <br /> 60 S • MA i tJ STPJ r MIF► t� ( <,� ,, <br /> ❑ Unit 2 <br /> 3. <br /> 4. .�� D Unit 3 <br /> 5. F D <br /> r \ <br /> 6. SAN ZM7 Unit 4 <br /> 7. <br /> $_ ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested. From to r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOUSING ABATEMENT O SOLID WASTE FACILITYIgYEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOYAL) ❑ DOG KENNEL ❑ DAIRY V <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FAcnm ❑MOTEL/HOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOL/SPA ❑ 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-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above b chocking the appropriate <br /> box es . At least one filet Y 9ve. A <br /> ( ) ype MUST be selected. Fax to(2091464-0138 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. ,t <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$95.00 deposit prior to review... <br /> EHD USE ONLY <br />