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1Z/16/ZUV6 lb:IU PAX Z001/001 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> IF, <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax- (209)464-0138 Web:www.sjgo <br /> 73 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 7777,77,77.�7,7­57 <br /> 77 <br /> L.kj2 r )rn - BUSINESSIAGENCY:0r"1'1-<'r '6'avle-PC--yq Z- <br /> ADDRESS: 50 &eMO/7-/ S>r 207� city/state/zip sq'i <br /> PHONE(1): _CVf-f) 591- -75,72- j PHONE(2): ('�VIS)5-71-7500 —FACSIMILE: ('/1-5)191 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must he confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> [Electronic Information: E]List 0 Map—Description: <br /> FC1UnFILE ADDRESS END USE ONLY <br /> ---Street# Street Name city <br /> E] Unit 1 <br /> it <br /> 2 <br /> [4. Unit 3 <br /> 5 <br /> 66. Unit4 rl <br /> 7, <br /> 8, ❑ Unit 5 <br /> 9. <br /> 10. . 0 UnIt6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT-MILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY M WASTE TIRE <br /> >0UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL M DAIRY <br /> >5MA7ARDOUS WASTE GENERATOR 0 CHICKEN RANCH E3 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FAciury 0 MoTELIHOTEL C3 PUMPER TRUCK/YARD/CHEM TOILETS <br /> E3 TATTOO/BODY PIERCING E3 POOL/SPA 13 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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 by checking the appropriate <br /> box(es). At least one file type 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 hold 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 now 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHb 48-06 B/04/08 PUBLIC RECORDS RELEASE APP-FORM <br />