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IVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY �-- <br /> ENV�NMENTAL HEALTH DEPARTIN T <br /> 600 East Main St. Stockton, CA 95202-270 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sileh <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: BUS INEESSIAGENCY: e_nt- <br /> vy <br /> ADDRESS: IV <br /> I rL�QN-Q!14, r <br /> PHONE 1): yl������ �j( PHONE(2): / AFACSIMILE:1Iy o"4W^2-6pZ��q,,� <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-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 081 2_b(e,:2 <br /> Electronic Information: ❑ List ❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 7 <br /> N, 7-KLrr= <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. <br /> 6. 4.fi <br /> 7 ❑ Unit 5 <br /> 9. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tU <br /> NERGROUND TANK(1ST)CLEANUP SITE(LHOUSINGABATEMENT C3SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITC�NON-LOP) C3FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 11DOG KENNEL Q DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 13 POOLISPA ❑ LA�N.D jJsE APPLICATION SI�TrES <br /> 13 ,,1!� <br /> MEDICAL WASTE FACILITY ..., OTHER(PLEASE SPECIFY) K dill ( 3 lJ6f <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 5:00 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance lease contact biane Martinez e (209)468-3425 directly. Thank You*** <br /> EHD 48-06 9/1412006 <br />