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v!l l L:Mr-li Cl V GU <br /> SAN JOAQUIN COUNTY t~U WV ryUMt3tK <br /> ENVI.,JNMEnTAL HEALTH DEPARTMiu NT <br /> C <br /> I>�R 1 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> lephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> N'$ g� h <br /> A PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i� L� 3� ��/lJ cyj (✓ BUSINESS/AGENCY: 7&)`rl C L <br /> ADDRESS: co 6)r V r---jU '—�z C— m 6 <br /> PHONE(1): 1 5`��( �Z"��-- PNO�E(2): of �/��� ( �d , FACSIMILE: l0 zj-Yi <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business d ys from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQ ES -$9 00 F,TCASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS^ESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE A ( T <br /> " <br /> UNIT DISTRIBUTION ❑ Unit 1 nit 2 offbnA3 nit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS <br /> f2.1 <br /> Street# Street Name City <br /> EHD USE ONLY <br /> 3 <br /> 3. LA <br /> 4. <br /> n rr � <br /> 6. <br /> IV y <br /> 8. C t�- U _ <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> G <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY ' <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER EATMENT PLNT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER RUC "AA <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND Us ,APP ICA❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM 1. List up to ten addresses in the space above. Select the type(s)of files f the list aboveappropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or m <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 enndifian as released reorgan;led by EVD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> i <br /> _ I <br /> i <br /> EHD 48-02-006 <br /> 11/23/04 <br />