Laserfiche WebLink
7 <br />DATE RECEIVED SAN JOAQIN NTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Vreephone: <br />1868 East Hazelton Avenue, Stockton, CA 95205 6232 qj (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: D"I t We— BUSINESS/AGENCY: <br />ADDRESS: 1 b _1 B6CV_jr_,D2 CITY/STATE/ZIP: <br />FRA <br />PHONE (1): 5 50—L/457-6013 PHONE (2): 530 --%'-�3-<n15- FACSIMILE: S'_"—C33-0)f7 <br />I/It/i3 <br />TENTATIVE* APPOINTMENT DATE: A5 3o' .s av /a%% Time: <br />(Please allow 10 business days from date of application submi I -*Tentative only- must be confirmed) <br />�CJ /1 JrCHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />i SIGNATURE OF APPLICANT_;nktihw��� ? DATE <br />o�- <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />YD USE ONLY <br />0] Unit 1 <br />Street # Street Name <br />City <br />1.)qqlCwkr <br />WA <br />G <br />11 , 10 12 <br />3. <br />9�iI ✓//'r <br />Unit 3 <br />4. <br />5. <br />} <br />J <br />lUnit4 <br />6. <br />r <br />7. <br />\ <br />To view the HMMP (Hazardous 1 E] Unit 5 <br />Materials Management Plan) go to the <br />following website: www.sjoesdata.org&nit s <br />9 <br />10. <br />xLe-5 <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTE FACIL IVEEHIC t <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT BNIASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL ❑ FOOD FACILITY ❑ DAIRY j S <br />ABOVEGROUND TANIY— ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLAN <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />❑.TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING ;2�COMPLAINTIRESPONSE RECORDS ❑ 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 $125 deposit prior to review. . *—BOXED AREA - EHD USE ONLY <br />111! �l 0 111111111 <br />�+ X1'3' arT <br />EHD 46-06 VWi(f ,�"'f_qo,_wP7z,09, <br />'A�" 16- o o �i K (t <br />W 0 0,2-, <br />