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DATE RECEIVED EHD LOG NUMBER <br /> 6AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> 0 -3420 Fax: (209)464-0138 Web: www.sjgov.org/ d <br /> 0 J; Telephone: (209)468 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> L <br /> APPLICANT: ;41 BUSINESSIAGENCY: <br /> ADDRESS: CITYISTATE/Zlp__ <br /> ,_'�6;��� 2 <br /> PHONE(1): 'j76-C _ ) 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 RgQUESTj;,1 5.00 FEE/(FASH 90"PECK��O�N Y)-REQUEST PROCESSED IN 3 BUSINFRS DAYS <br /> . - ZZ;57 <br /> SIGNATURE OF APPLICANT_7��r_ ._ 'A� 7011::�4 DATE <br /> � <br /> Electronic Information: ❑ List 0 Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 2. Sit 2 <br /> 3. 9,3 e).,) �_3 <br /> 4. <br /> nit 3 <br /> 5. <br /> 6. nit 4 <br /> 7. D Unit 5 <br /> 8. <br /> 9. unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> YUNDERGROUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT /SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) 1:3 FOOD FACILITY 11 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 13 MOTELMOTEL 0 PUMPER TRUCKIYARD/CHEm TOILETS <br /> E3 TATTOO/BODY PIERCING 13 POOL/SPA 'K�LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5: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 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$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 48-06 810412008 <br />