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DATE RECEIVED EHD LUG NUMBER <br /> SAN JOAQUIN COUNTY IS <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-2708 <br /> 71 'U01d Telephone: (209)468-3420 Tax: (209)464=0138 Web: w,,v sw ov.o /e <br /> ,3 1 <br /> T H <br /> Z j;7- <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l Iv 1'�,�Y1 i r (t 1 BUSINESSIAGENCY: <br /> ADDRESS: -fX G>� i sgC_AW(.f ( r 0 w qy <br /> PHONE(1):_o © _ 15 s Q "( /S —PHONE(2): 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-$98.00 FEE(CASH OR CHECK ONLY QUEST PROCESSED IN 3 B SIN SS DAYS <br /> r <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. oCe <br /> 2. ❑ Unit 2 <br /> 3. <br /> f <br /> Unit4 . <br /> 6. <br /> 7. <br /> ❑ Unit 5- <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE J t <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL)DC ❑ DOG KENNEL 0 DAIRY <br /> CI HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 13 TATTOOIBODY PIERCING ❑ POOL/SPA 11 LAND USE APPLICATION SITES <br /> 13 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 END 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** If you should need further assistance please contact Diane Martinez C (209)468-3425 directly. Thank You*** <br /> -I Z /7 <br /> EHD 48.06 9/14{2006 <br />