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Fpr 01 11 04: 48p p. 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> �K ENVIRONMENTAL HEALTH DEPARTMENT o <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> (n{�F Telephone: (209),468-3420 Fax: (209)464-0138 Web: wwwsjgov.org/ehd <br /> l PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY: - <br /> ADDESS: CITY/STATE/ZIP: <br /> PHONE (1): C , j - )�y-(tl(�(� - PHONE(2): `1�1 2-SQ FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time. <br /> (Please allow 10 business days from date of application submittal-'Tenfat/ve only--must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITER UE,`iT-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT )t �U -_- DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# - Street Name City <br /> El 1 <br /> 4- - - ' <br /> Z L,'unit 2 <br /> 3. <br /> 4. <br /> — ---- - - tit 3 <br /> 5. <br /> 6. <br /> -- - -- ----- -- LTJ unit4 1 <br /> 7. <br /> 8. - - —-- -- - --- - O unit s <br /> 9. <br /> 10. - - <br /> ❑Unit 6 <br /> Specific Date Range of Inf'>rmation Requested: From 1 1 q 010 to Df e 5'�n�- <br /> EN1rIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(us r)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY []WASTE TIRE <br /> UNDERGROUND TANK(MO NITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILI-Y ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOIL FTS <br /> ❑ <br /> TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITI ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addree,ses in the space 2 bove. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least on�file type MUST b t�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 END. Applications received after <br /> 3:00 pm will be processed the next bu:;iness day. <br /> 2. The EHD will notify I he applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The I les 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 returnee 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$122 deposit prior to review. <br /> USE ONLY <br /> EHD 46-06 - - - 07/29/10 <br />