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SAN JOAQUIN COUNTY <br /> E+NVIRONMENT.4L HEALTH DEPARTMENT cc 0 <br /> 2007 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone; (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.arg/ehd <br /> 91 <br /> r-re16 <br /> P BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: 4t 1 <br /> PHONE(1): PHONE(2): FACSIMILE: GI 9 <br /> TENTATIVE'AP INTMENT DATE: Tlma: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be canfirmad) <br /> CHECK BOX TO EXPEDI E REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ ist❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Name my ❑ Unit 1 <br /> N°Dg-cp- <br /> 2. <br /> 4_ A�ya� <br /> 4. M i /YT nit3 <br /> 5. <br /> 6. � <br /> Unit 4 <br /> 7. <br /> s ❑ Unit 5 <br /> 9. <br /> -' -- <br /> 10E] unit 6 <br /> . -- <br /> Specific bate Range of Informatiin Requested: From to <br /> f ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L I DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY/VEHICLE <br /> �TH R CLEANUP SITE(NONLOP) IL ❑F000 FACILITY ❑WASTE TIRE <br /> MRGROUND TANK(MONITORINOIREMOVAQ ❑ Do6 KENNEL L7 DAIRY <br /> HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL Cl PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA 0 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 AMS:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the pace above. Select the type(s)of files from the Ilst above by checking the appropriate <br /> box(es). At least one file type UST be selected. Fax to (209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted—f r additional assistance with file addresses,contact the EHD.Applleations received after <br /> 3:00 pm will be processed the (nIext business day. <br /> 2. The EHD will notify the appllcaV t if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of applicatio 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 worl�ed on by END staff may not be Immediately available for review. A new application may be <br /> submitted when the file is avail ble. <br /> 4. Any file not returned in the so 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$98.00 deposit prior to review. <br /> EHD USI=ONLY <br /> EHD 48-05 WEB—CiErz007 <br /> TB 39dd Tb8Z86L81CT L0 :69 LaOZ/9Z/60 <br />