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FROM ERAS E—i ro----tai, 1 n _ [T.HU)MAY la 2011 15'..!E; . l B[Sfl�Ho.7500000470 P "1 <br /> 4 EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> � �� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton; CA 95202-3029 <br /> M � � Atephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.arglehd <br /> AY <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A ONMES v 13US(NESSIAGENCY: <br /> ADDRESS: ` c CITYISTATEIZIP: <br /> PHONE(1): c.5 V-A14 7. 106 ��HONE(2). �3�-d� FACSIMILE:.$�`�4^����3�� <br /> TENTATIVE"APPOINTMENT DATE: Time: , <br /> (Pisase allow 10 business days fromdate of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 E(C H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT' DATE ( � t <br /> Electronic Information: ❑ List❑ Map--Description: <br /> 4 FILE ADDRESS . EHD USE ONLY <br /> 4 Street# Street Nam* City ❑Unit 1 <br /> J <br /> 2. � 1 [4 ( t Ll�� � 3 ❑Unit 2 <br /> I` 3. `-1 1 Www <br /> 4. Unit 3 <br /> 5. <br /> 6. nit 4 <br /> 7. <br /> S. ❑Unit 5 <br /> g. <br /> 10. 1 ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> hit <br />{. ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(ICON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br />[ NDERGROUNo TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> I ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 11 <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> r WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to tan 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 ve. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:04 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. <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 6122 deposit prior to review. <br /> EHD USE ONLY <br /> 0712917 a <br /> EHD 48-08 <br />