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DARMp V�IV/EO SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> EI'IRONMENTAL HEALTH DEPART*--NT <br /> IN; �j 6 20�zz09g)f 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMOYTHf Xttrpclne: (209) 468-3420 Fax: (209) 464-0138 Web: WWW.sjgov.or <br /> P€RMITISfflVfvE PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1) Q PHONE (2): ^ 7[1 5 FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE: D F- 9—13 Time: ? <br /> (Please allow 10 business days from date of application submittal--Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE QUEST-$115,`0o F (CASH OR CHECK ONLY)-REQUEST PROCESSED INUSINE//SrrS--��DAYS <br /> SIGNATURE OF APPLICANf.J , DATE ` 13 BlJ <br /> Electronic Information: ❑ List❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City <br /> 1 ❑Unit 1 <br /> 2. <: <br /> - 4 <br /> 3. 4 <br /> 4. I <br /> 5 ❑Unit 3 <br /> 6. <br /> T ❑Unit 4 I� I <br /> 8. <br /> ❑Unit 5 <br /> 9. veri C&F1GIT t710 2S <br /> 10. Ie-1; +0 be- fedie oed m'A- N emh <br /> It ISI ❑Unita <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> ❑OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY E]SOLID WASTE FACILnYNEHICLE <br /> ❑ MONITORINGIREMOVAL ❑WASTE TIRE <br /> UNDERGROUND TANK <br /> ( ) ❑DOG KENNEL El DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH UWASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL M PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA <br /> F1 MEDICAL WASTE FACILITY El LAND USE APPLICATION SITES <br /> ❑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 types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be 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 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 (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$115.00 deposit prior to review. <br /> END USE ONLY <br /> ***If you need further assistance please contact Diane Martinez directly @ (209)468-3425. Thank You*** <br /> CNM1 IAIMt <br />