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r DATE RECEIVED � <br /> SAN JOAQUIN COUNTY EMOtOG NUNS <br /> _ EWIRONMENTAL HEALTH DEPART <br /> 600 East Main St. Stockton, CA Telephone: (209)68_342Q Fax: 209)464-0138 Web. ww 8 <br /> u++ w.sjgov. <br /> PUIPLIC RECORDS RELEASE APPLICATION , <br /> APPLICANT: <br /> �BUNESS/AGENCY: <br /> ADDRESS: CITYISTATEIZIP: <br /> PHONE(1): a Z(PL C73�C� PHONE(2): FACSIMIL <br /> TENTATIVE*APPOINTMENT DATE: 6a 4 <br /> (Please allow 10 business days from dae tof application submittal-"Tentative only-m t be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name city <br /> 2. e r <br /> 3. _ <br /> 4. <br /> 5. Jnit 3 <br /> 6. <br /> 7. <br /> /0.040�It 4 <br /> � O unit 5 <br /> 10. <br /> Specific Data Range of Information Requested: From Jnit 6 <br /> �� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> [:]TIERED PERMITTED FACILITY [3IHOTEL <br /> MOTELEl WASTEWATER TREATMENT PLANT <br /> ❑TATTOOI8ODY PIERCING El PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> E] U IT <br /> MEDICAL WASTE FACY ❑Poo11SPA ❑LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL.AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVNEw MONDAY-FRIDAY 8:00 AM-6:00PM(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 appropriate <br /> box(es). At least one file type MUST be selected, Fax to 208 484-0138 or mall 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 END 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 /> EHD USE ONLY <br /> ***If you need further assistance Please contact Diane Martinez direct! @ (209)468-3425. Thank You*** <br /> F"n AA" <br />