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1234 KLEINFELDER " 70:12 03-01-2010 1l1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> ESAN JOAQUIN COUNTYr _,E�1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> �� D 600 East Main Street Stockton CA 95202-3029 <br /> 5202 3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: ehd5b <br /> ENVROM-,.t: -v,ijiiFAITH PUBLIC RECORDS RELEASE APPLICATION <br /> F'ER.M,IT�6E W"`' {. nn BUSINESS/AGE Y: <br /> ADDRESS: .1� �\ l' 95'57 <br /> PHONE(1):_2'� - V�J� PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow ten business days fr7FEj <br /> of application submittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$98.00ASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name City C3 Unit 1 <br /> 2. <br /> 3. � 1 ❑Unit 2 <br /> — ) <br /> 4. --� s• , nil 3 <br /> 5. 1 <br /> 6. -- -- nit <br /> - <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> '�U DERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ERGROUND TANK(MONITORINGIREMOVAL) C3 Dor,KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL�.,j/1_l�OTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING (0POOLISPA ❑LAND I_SE APPLICATION SITE <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) 00 to <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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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 rile reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4"6 10129/07 PUBLIC RECORDS RELEASE APP FORM <br />