Laserfiche WebLink
ECE <br />VED <br />DAT RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY a � '' <br />MAY 2 6- 2016 ENVIRONMENTAL HEALTH DEPA '�"� � . • � <br />1668 East Hazelton Avenue, Stockton, CA #952?6V F <br />a MRQ.r.VIEI�£f.A EALTFt Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />pEM&jTiSEFZv10E, ,7 PUBLIC RECORDS RELEASE APPLICATION <br />: <br />APPLICANT}—+ T i ( BUSINESSIAGENCY: LANG A -m 7Q <br />ADDRESS: I\ j 0_090 eja _ L -.4,1,e, _` l ) rri 1._ l f) CITY/STATE/ZIP:(�- <br />PHONE (1): C PHO14E (2): FAX OR E-MAIL: �- <br />1t i. <v ( r.�a,�..1 <br />� <br />� <br />Please allow 10 business days from date of application submittal for the records to be available. U <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT Mn n l�� OV DATE Q _�: � 2-6 12_0 /-6 <br />1. List uD to ten addresses in the space below. Select the type(s) of files from the list below 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. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. 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 />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 $130 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: (MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map - Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTFAENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />i <br />(- UNDERGROUND TANK (UST) <br />T' <br />Street # <br />Street Flame <br />city <br />I`gPrg_1 P0s ft 9_0""D <br />S-T0Cx_TVN <br />f CONSUMER <br />CLEANUP SITE (LOP) <br />x 1 OTHER CLEANUP SITE (NON -LO )��� <br />El DNRY ; <br />F?I HAZARDOUS.JASTE <br />TIERED PERMITTED FACILITY <br />ABOVEGROUND TANK <br />LJrWa <br />UST (MONITORING/REMOVAL) <br />HAZARDOUS MATERIALS <br />( l <br />I� /� yQ (O�C•d ©�-� IS�h <br />S�� /v/ <br />Cj �C� <br />}� SPILURELEASE RESPONSE <br />F-1SOLIDWASTE FACILITY/VEHICLE <br />V InOS^ <br />ALITY <br />/C, ^ . <br />/C(n [g WATER (U <br />[in <br />❑ FOOD FACILITY <br />❑DAIRY POOL/SPA <br />�`K <br />V`-'i <br />-� ,UK <br />S�Lct`-y, Q, r <br />Q'SITE MITIGATION <br />ic k C� <br />❑ LAND USE APPLICATION SITES <br />SEPTIC PUMPER TRUCK/ <br />TOILETS <br />' " <br />rr [� %�/} <br />` I C -T `4'!'" <br />C <br />���(V <br />HOUSING <br />I "kwm <br />(`❑^`,j'n/YARD <br />/ CHEMICAL <br />? <br />I � <br />9� //' <br />) (7 "I <br />gV /f,>1 <br />n� <br />��r. <br />(�j�_ <br />® CCUUTA <br />F] WASTEWATER TREATMENT PLANT <br />HOUSING ABATEMENT <br />MOTEL/HOTEL <br />❑ CHICKEN RANCH / DOG KENNEL <br />UPA - HAZ•MAT <br />I �i PN-) <br />MEDICAL WASTE FACILITY <br />( <br />,J r 1 W t <br />❑ TATTOOIBODY PIERCING <br />I] SOLID WASTE <br />❑ WASTE TIRE <br />S <br />❑ COMPLAINT <br />Y El ACCOUNTING <br />❑ OTHER(PLEASE SPECIFY): <br />10 <br />***BOXED AREA - EHD USE ONLY' <br />