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Dar ""� I " E 0 SAN JOAQUIN COUNTY ��� � <br /> 6�MAR 12 2012 ENVIRONMENTAL HEALTH DEPARTMENT t/ <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> ENVIRONMENTAL HEALTH <br /> Rush <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE(1): Q PONE (2): /x47 FACSIMILE: <br /> TE TATI E' N NT DATE: Time: <br /> (Please allow 10 business days from data of application submittal- Tentative only-must be confirmed) <br /> XHECK BOX TO EXPEDITE REQUEST-$1 H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLI DAT / <br /> Electronic Informatio List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Sirt# Street Name City <br /> 3. 00 unit 2 <br /> 4. '*� !" <br /> Unita <br /> 5. <br /> Z i <br /> 6. <br /> 7. <br /> Fllfol,, ,,dun,14 <br /> 8. <br /> - -- ❑Unit-5- <br /> ❑Unit 6 <br /> Specific Dale Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,-J�JIINDERGROUND TANK(UST)CLEANUP SITE(LOP) ElHOUSING ABATEMENT ❑SOLID WASTE FACILITYfVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> r��yI�INDERGROUND TANK(MONITORINGIREMOVAL) El DOG KENNEL ❑DAIRY <br /> �,r AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ❑TATTOO/BODY PIERCING ❑PUMPER TRUCKICATION SITES TOILETS <br /> ❑POOL/SPA El LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS <br /> ❑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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHO 4a-e6 <br /> 8/1111 <br />