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DATE RECEIVED EHD LOG NUMBER <br /> JAN JOAQUIN COUNTY <br /> L <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> 'T <br /> -3420 Fax: (209)464-0138 Web: www.sigov.org/` d <br /> ��E 0 Telephone: (209)468 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a4, _7 7 BUSINESS/AGENCY- <br /> ADDRESS: CITY/STATE/ZIP <br /> PHONE 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 /> C3 CHECK BOX TO EXPEDITE REQUEST,-$ 5.00 FEEfFASH 0 ECK ON Y)-REQUEST PROCESSED IN 3 SINE S DAYS <br /> DAT <br /> 0 E <br /> SIGNATURE OF APPLICANT_77�s: P�Z_ —7 <br /> Electronic Information: El List El Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit I <br /> 1- 03701 <br /> 2. ` Unit 2 <br /> kjo /WO <br /> Unit 3 <br /> 4. /1101 <br /> 5. nit 4 <br /> 6. <br /> 7. El Unit 5 <br /> 8. <br /> 9. Unit <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ; k /VEHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> HER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 13 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) <br /> G/REMOVAL) E3 DOG KENNEL 13 DAIRY <br /> " ZARD 0US WASTE <br /> A TE GENERAT R <br /> E3 CHICKERANCH 13 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 13 MOTELIHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> E3 TATTOO/BODY PIERCING 13 POOL/SPA LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 13 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 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(209)4640138 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need-further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You` <br /> EHD 4"6 8/04t2008 <br />