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Ile <br /> EHD LOG NUMBER <br /> -RECENED - +-" SAN JOAQUIN COUNTY <br /> `j `` ENVIRONMENTAL HEALTH DEPARTMENT <br /> f 1868-East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC. RECORDS RELEASE APPLICATION <br /> APPLICANT: O�ar� BUSINESSIAGENCY:, <br /> ADDRESS: t� a� CITYISTATEIZIP: a S <br /> PHONE(1}: /� PRONE(2): FACSIMILE: �e0 fly <br /> TE IVE*APPOINTMENT DATE: Tt be <br /> (Please allow 10 business days a of application submittal-*Tentative only must be confirmed) <br /> 4 ❑CHECK BOX TO EXPEDITE REQUE $ E ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS S DAYS <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. S Lx1 <br /> 2. <br /> D Unit 2 <br /> 3, <br /> 4. Unit 3 <br /> 5. 1 1e War- <br /> 6. <br /> ar— <br /> t <br /> S ❑�Unit4 <br /> 7. <br /> 8. <br /> J ❑Unit 5 <br /> l 9. <br /> 10. ❑Unit"6 <br /> Specific Date Range of Information Requested: ,From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d NDERGROUND TANK(UST)CLEANUP SITE(LOP) F1 MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICE E <br /> i QTHER CLEANUP SITE(NON-EAP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ElFOOD FACILITY ❑DAIRY <br />( ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUSWASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTQILETS <br /> i ❑TIERED PERMITTED FACILITY ❑POOLfSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑.OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:ODPM(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 MIDST be selected. Fax to(2091464-0138 or mail to the address indicated above. Address <br /> ranges will notbe accepted-#or 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(1,0) <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 Js 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 /> ii Future file reviews by the same applicant may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> © Records provided by Staff-PPR Complete—Staff Name: <br /> EHD 48-06 _ 914!12 <br />