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y t a 12 {5 5 &s. <br /> 304 East Weber Avenue, P Floor, Stockton,CA 95202-2708 <br /> AUG 3 2005 Telephone.(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orglehd <br /> �1�VtRDNMT HSS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: = f-1 5 BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE(l): PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submidai•`Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE UES ;93.00 FEE( HO CHECK ONLY)-REQUEST PROCESSED-IN 3 BUSINESS DAYS <br /> F`SIGNATURE OF APPLICANT DATE 0-S J <br /> I1NIT DISTRIBUTION ❑ Unit i ❑Unit 2 ❑Unit 3 nit ''❑ Unit 5 4 Unit fi C3 Other(electronicllistslmaps} <br /> FILE ADDRESS EHD USE ONLY <br /> Street it S t Name City <br /> ZZCcl, <br /> 3. <br /> 4. <br /> 6. <br /> 7. <br /> s. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ONwRGRo=TANK(UST)'CLEAuup SfTE(LOP) - 0 HOUSING ADATMENT 0 SOLID WASTE FAcujTYNEmcLE <br /> THER CLEANuP Smc(Nott-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND YANK(MONITOftINGIREAAOYAL) ❑DOG KENNt=1 DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR C}00cKm RANCH ❑WASTEWATER TREATMENT PLANT' <br /> ❑'TIERED PERMITTED FACILITY 0 MOTELIHOTEL: ❑PUMPER TRucMARD/Cmm TotLm <br /> d TATTOOISOOY PIERCING T]POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FkioAY$:00 AM-6:00PU - 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 <br /> appropriate box(es), At least one file type MUST be selected. Fax to 209 464-0438 or mail to the address <br /> Indicated above. Address ranges will not be accepted'--for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 wilt be confirmed <br /> approximately ten(10)days after receipt of'opplication. The files will be held for a maximum of five business <br /> days for review. AppointriTents 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 <br /> application 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. . <br /> EK0 46-02-006 .. - <br /> -11123104 - <br />