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DATE RECEIVED ^ ' EHoLOG NUMBER <br /> SAN JOAQUIN COUNTY . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 18O8East Hazelton Avenue Stockton, CA �� � ��� <br /> FEB � � ?O1� ' ' �� ^� w�.�w <br /> �~ ~ ~ ^~^^Tm/ephona: (209) 488-3420 Fax: (209) 464-0138 Web: vvvvvv. gov.org/ehd ��� ^�~ � <br /> PUBLIC UC RECORDS RELEASE APPLICATION <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1): PHONE (2): -" FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 1Ubusiness days from date nfapplication submittal'*Tentative un|y'mustbecon5rmod) � <br /> ElCHECK BOX TnEXPEDITE REQUEST $1 cEGSEo|mnBUSINESS DAYS <br /> SIGNATURE QFAPPLICANT DATE <br /> Electronic Information: 0 List E] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city El Unit 1 <br /> 4. jj Unit 3 <br /> 5. <br /> 7. <br /> 8. El Unit 5 <br /> 9. <br /> 10. El Unit 6 <br /> Specific Date Range nfInformation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE P) SOLID WASTE F4o|UTY8/ H|oLE <br /> THER CLEANUP SITE(NON-LOP) F]HOUSING ABATEMENT WASTE TIRE <br /> NosRGnVVNoTANK(MoN|7on|wG/RsMoxAU DAIRY <br /> UNDERGROUND <br /> DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS W«Src/H*axR0000MATERIALS F1 MOTELIHOTEL []PUMPER Tnuox0Ann/CHsm|nALTOILETS <br /> TIERED PERMITTED FACILITY DPOOLISPA D LAND USE APPLICATION SITES <br /> LJT4T7oo/BoovPIERCING I J1Compux|wlYRsapownsRECORDS DOTHER(PLEASE SPECIFY) <br /> WELL SEPTIC PERMIT RECORDS ARE AVAILABLE Fl &1 F Am-5:00pm(EXCLUDING HOLIDAYS) <br /> SUO <br /> 1. List up to ten addresses inthe space above. Select the typo(o)offiles from the list above bychecking the appropriate <br /> box(es). Atleast one file type MUST beselected. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:OOpmwill beprocessed the next business day. <br /> 2. The EHDwill notify the applicant ifany EHDfiles exist. Anappointment for review will boconfirmed approximately ten (1O) <br /> days after receipt ofapplication. The files will boheld for omaximum offive business days for review. Appointments <br /> should boscheduled accordingly. <br /> 3' A file that is actively being worked on by EHD staff may not be immediately available for review. Anew application may be <br /> submitted when the file iaavailable. <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 bythe same applicant may require a$125deposit prior to review. —BOXEDAREAEHD USE ° <br />