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DATE RECEIVED tnu w�Ivunncstrc <br /> * SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web-www.s.gov_.or ehd _0150____ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSIN <br /> ES <br /> S/AGENCY: . " <br /> ADDRESS: Y"D /'j CJ �`' � C1, il�� ►- '�Z O� <br /> PHONE(1): �P 3rp q39 /// PHONE(2): 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 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTATE <br /> of <br /> UNIT DISTRIBUTION Unit 1 Unit 2 Unit 3 nit 4 runit 5 Anit 6 0110ther(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. b'q <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) OUSING ABATEMENT LID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) OOD FACILITY ASTE TIRE l <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL AIRY l <br /> HAZARDOUS WASTE GENERATOR HICKEN RANCN 11- ( ASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY OTEL/HOTEL YY PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING OOL/SPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY THER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAB E OR REVIEW - MONDAY-FRIDAY 8:00 AM-S:OOPM - 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 <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 prior to review. <br /> EHD 48.02.006 <br /> 11/23/04 <br />