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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVMONMENTAL HEALTH DEPARTMENT <br /> FEB 2 G 2007 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> ENVIRONMENT HEALtH Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERM IT/SE gVICES 7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _cnl � BUSINESS/AGENCY: UF— CCs;- <br /> ADDRESS: <br /> PHONE(1) 1 - G \2-aO2j� PHONE(2): ��b�f�`7�'t �22�'t� FACSIMILES-j70 `ffSS- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 bARUE <br /> from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPED $95.00 FE R CAf VK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z-A^o-? <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 2. <br /> 3.. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> r� DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYN <br /> E LE <br /> R CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> LBJKDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> X,2 <br /> EHD 48.06 <br /> 8/1/06 <br />