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DATE RECEIVED EHD LOG NUMBER <br /> SAN J OAQUIN COUNTY <br /> — LNC Ir.vNAIENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, ('A 95202-2708 <br /> APR 1 HE Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> EN IIQ(,i ;�; <br /> P�Fl;? T!-� ,/ ,,fit. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��1� ` { I� BUSINESS/AGENCY: <br /> ADDRESS: /� <br /> PHONE(1):�/)��'�`yi i ��J'7 PHONE(2): � �lJ(Gl " l��-� FACSIMILE: � 6 (JJU <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITW�QU - 0 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3PUSINESS DAYS <br /> SIGNATURE OF APPLICANT �— DATE l <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. L L.iuv 4t I /Unit 2 <br /> 3. <br /> ❑ nit 3 <br /> 114. 'L'rl <br /> 5. <br /> 6. Unit 4 <br /> 7. <br /> - ❑ Unit 5 <br /> 8. <br /> 9. <br /> /Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE PC � <br /> HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY WASTE TIRE ✓ ////''''������ <br /> WNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR El CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL Ej MPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOL/SPA X-I 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 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 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 Ell-I'D staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> **' If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 48-06 9/14/2006 <br />