Laserfiche WebLink
UAIVH Lr- UNi0.ol rnvn T-5171 Y17141/d171 F-788 <br /> ■ <br /> • SAN JOAQUIN COUNTY enu Luu rvvmntr< <br /> • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ■ � 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Nyphone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ftVIRpNME <br /> pF Nr,�� _ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: lC�� BUSINESS/AGENCY: tg� Cg(Zp �^I <br /> ADDRESS: CITY/STATE/ZIP: ( a <br /> PHONE (1): _[t,- 2�V] PHONE(2):a��I ,I.��-�j �a�� FACSIMILE: (q_(st�L <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> ,Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REO T-$1 0 FEE(C H OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINE55 DAYS <br /> SIGNATURE OF APPLICANT G DATE [ <br /> Electronic Information: ❑ List❑ Map-De ription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit i <br /> 2 l$ t7D —a k)('(` ❑ unit <br /> 4 ti / ) <br /> t —, A.ffAQv ( vNQ "unit 3 <br /> 5. <br /> 6. <br /> ❑,UnR 4 <br /> 7. R%xit5I 5 Ftley <br /> a. <br /> Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Informatlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑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(2091464-0138 or mall to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:013 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 conditlon as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future filereviewsby the same applicant may require a $130 deposit prior to review. "'BOXED AREA-EHD USE ONLY"' <br /> Lfv.H�el `'K f7Z✓ Ak I l,J 1g 'Otte `t'(,v CtN -6!,_: �1t lilt' fe 'LvW <br /> ❑ Records provided by Staff-PPR Complete, Staff Name: <br /> EHD 4006 <br /> BB101/1A <br /> Received Time Feb. 27. 2015 1 :31PM No. 8231 <br />