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UU I —Iib—;20by 12:31 <br />am <br />EHD LOG NUMBER <br />RECISM0 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />oi,j 06 2009 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.o e <br />mvft� "'nr� HEALTH PUBLIC RECORDS RELEASE APPLICATION 7 <br />Itz <br />APPLICANT: <br />ADDRESS:�- <br />PHONE (1) , , PHONE <br />TENTATIVE* APPOINTMENT PATE: _A <br />PL{010Al2— (Please allow 10 business days from date <br />10/o/mi --)'*HECK BOX TO EXPEDITEREQ T - 5 FEE <br />SIGNATURE OF APPLICANT <br />BUSINESS/AGENCY:4��Asc -rre- <br />CITYISTATE/ZIP:ADM &t <br />�-7/,4i FACSIMIL ' <br />Time: <br />on'submittal - "Tanfattva only - must be confirmed �— <br />CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE /d AG /,# <br />Electronic Information: ❑ List 0 Map — Description; _A <br />P) <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />001HER <br />ERGROUNn TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHCLE�- <br />CLEANUP SiTE (NON -LOP) ❑ FOOD FACILITY 0 WASTE TIRE <br />ERGROUND TANK (MONiTORiNG/REMOVAL) El DOG KENNEL F1 DAIRY <br />AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT ry <br />© TIERED PERMITTED FACILITY ❑ MOTEIIHOTEL Q PUMPERTRUCK/YARDICHEMICAL TOILETS <br />❑ TATTO BODY PIERCING 0 POOL/SPA ❑ LAND USE APPLICATION STIES <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 Wn 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 fila type MUST be selected, Fax to ( 09)464-013$ or mail to the address in icated $bove 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 EHO files exist. An appointment for review will be confirmed approximately ton (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 $115 deposit prior to review. <br />S. If you need further assistance, please contact Diane Martinez, at (209) 466-3425, <br />ONRE1111911I <br />