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SAN J OAQUIN COUNTY - - -- - _ <br />E ONMENTAL HEALTH DEPAR NT <br />304 East weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />PHONE (1): , 16V4?"- 7 30s' PHONE (2): i4 0 22L56/5"'97c2 a 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 - $93.00 <br />SIGNATURE OF APPLICANT <br />OR CHECK ONLY) --REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE <br />UNIT DISTRIBUTION ' ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 E3 Unit 5 ❑ Unit 6 ❑ Other (electronicnists/maps) <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name city <br />lip <br />N <br />13 <br />Specific Date Range of Information Requested: From <br />to <br />t <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) E3 HOUSING ABATEMENT E3 SOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY 13 WASTE TIRE <br />NDERGROUND TANK (MONITORING/REMOVAL) C3 DOG KENNEL 13 DAIRY <br />AZARDOUS WASTE GENERATOR E3 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br />UNDERGROUND <br />PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ 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 typo(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 $93.00 deposit Drior to review. <br />