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,DATF--1Z'_CEIVED <br />SAN JOAQUIN COUNTY S.� <br />�. ENNTIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSI <br />ADDRESS: (jI <br />4 , � "2)y 4 � CITYISTATEIZIP_L <br />PHONE (1): �u PHONE (2): <br />ENCY: <br />FACSIMILE: -) ID " - <br />TENTATIVE* APPOINTMENT DATE: Time: ~ <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />171 CHECK BOX TO EXPEDITE REQUEST - $115.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />EHD LOG NUMBER <br />DATE <br />electronic intormation: U List U Map - Description: <br />FILE ADDRESS <br />Street # Street Name City <br />EHD USE ONLY <br />❑ Unit i <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ WASTE TIRE <br />,,...,,,{{{ <br />y� UNDERGROUND TANK (MONITORINGIREMOVAL) <br />2. <br />DAIRY <br />/t HAZARDOUS WASTE GENERATOR <br />1:1 CHICKEN RANCH <br />❑ Unit 2 <br />3. <br />ED MOTELIHOTEL <br />PUMPER TRUCKIYARDICHEM TOILETS <br />E3 TATTOWBODY PIERCING <br />4. <br />5. <br />fl LAND USE APPLICATION SITES <br />E7 MEDICAL WASTE FACILITY <br />E7 OTHER (PLEASE SPECIFY) <br />Unit 3 <br />t <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br />Unit 4 <br />6 <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />C3 HOUSING ABATEMENT <br />0 SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ WASTE TIRE <br />,,...,,,{{{ <br />y� UNDERGROUND TANK (MONITORINGIREMOVAL) <br />1:1 DOG KENNEL <br />DAIRY <br />/t HAZARDOUS WASTE GENERATOR <br />1:1 CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />ED MOTELIHOTEL <br />PUMPER TRUCKIYARDICHEM TOILETS <br />E3 TATTOWBODY PIERCING <br />❑ POOLISPA <br />fl LAND USE APPLICATION SITES <br />E7 MEDICAL WASTE FACILITY <br />E7 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 (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 END 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 $115.00 deposit prior to review. <br />EHD USE ONLY <br />I <br />***If you need further assistance please contact Diane Martinez C (209}468-3425 directly. Thank You*** i <br />