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X,- <br /> DATE RECEIVED � EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY "` <br /> U j i ,lL ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> : } �gegTelephone: (209)468-3420 Fax: (20g)464-0138 Web: WWW.sjgov.or <br /> 4 5S// <br /> "!f1FEA K PUBLIC RECORDS RELEASE APPLICATION <br /> APPUNY J >r �� r1 Y T� BUSINESS/AGENCY: <br /> ADDRESS: ��� 2_Z-.7 ,j d I [1 f't Lr-r _ CitylStatefZi .�✓ '� y5 y <br /> PHONE PHONE(2> `r'Ta � FACSIMILE: <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 EXPEDITE REQUEST-$105 FEE(CA§H OR CHECK ONLY)-REQUEST PROCESSED IN BUSINE S DAYS <br /> SIGNATURE OF APPLICANT DATE / y <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑ Unit 1 <br /> 2, ❑ Unit 2 <br /> 3. <br /> _4_--- - - - Unit r/ <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7, <br /> ❑ Unit 5 <br /> 13. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLfeE <br /> �THER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> �E' HAXARDOUs WASTE GENERATOR Q CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> E3 TATTOOIBODY PIERCING d POOL/SPA d LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 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. r J� ,/ /1 - .��rL.?� f J �jf GAJ f=Yv/(4_1� <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$105 deposit prior to review. <br /> EHD USE:ONLY - <br /> EHD 48-06 8104108. PUBLIC RECORDS RELEASE APP FORM <br />