COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

08/20/2014 14:47 FAXour% 0 002/002 DATE RECEIVED `� ;XT_ _ SAN JOAQUIN COUNTY HD J �"` " ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ASG 6r44hone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd RECORDS RELEASE APPLICATION APPLICAW. ol�'a L a BUSINESS/AGENCY: ADDRESS: S+G 00 CITY/STATE/EIP: j e,_�) ICO f�, PHONE(1): PHONE(2):_),p •'4-0 FACSIMI : Please allow 10 business days from date of application submittal for the records to be available. ` Staff will contact you to arrange an appointment date and time to review the requested records. 4A ,vf J CHECK BOX TO EXPEDITER EST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIG/NATURE OF APPLICANTo DATE 1p f/c�• Electronic Information: ❑ List❑ Map—Description: FILE ADDRESS EHD USE ONLY Street 0 Street Name City ❑Unit 1 '• , n . HCA Vv%R):zM� oocz,,)p 1\ _ I-4,.,� �� ,o�+�. hm, �S iMM unit ioo ccsp�-t44 3 t i❑Unit 3 351• ? 2 yJ g JShJ It 4 7. 1 8. ❑Unit 5 9. CA"vy 10' L 0 Unit 6 Specific Date Range of Information Requested: From OD to A ,.t ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYIVEHICLE ?/ 5� THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE a UNDERGROUND TANK(MONITORINGIREMOvAL) ❑FOOD FACILITY ❑DAIRY V ❑g*3OVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT '�& �r 21AZARDOUS WASTEIHA7ARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL ToLETS lam' ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES ❑TATTDOIBODY PIERCING ❑COMPLAINTIRESPDNSE RECORDS ❑OTHER(PLEASE SPECIFIC) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00pm(FUCLUDINO HOLIDAYS) 1. List up to ton addre4i�Qs_In the apace above. Select the type(e) of Pilon from the list above by chocking the appropriate box(ea). At least one file type MUST be selected. Fax to(209)464-0138 or mall to the address Indicated above. Address ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. 2. For assistance In Identifying the nature and content of EHD records,please contact EHD at the number noted above. 3, The EHD will notify the applicant If any EHD files exiat. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$125 deposit prior to review, —BOXED AREA-EHD USE ONLY' al Ft L3015 7 th, G r, 2Ji i m 4 Cr. S Seer �'�t ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 4&0a VM4 Received Time Aug. 20. 2014 1 : 51PM No. 6874