Laserfiche WebLink
11/04/2008 11:08 9259442859 TSG PAGE 01 <br /> C ,L�u1i EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> til;v 2008 ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 zwf <br /> E!`Jdl'N(.NMILE VT HEALT.Hrelephone: (209) 468-3420 Fax. (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: YLt C� BUSINESS/AGENCY: 1'V SwyrCR <br /> ADDRESS: 3 5 C V�h'�n� Y�v� City/State/zip � ' 2 <br /> PH0NE(1): FONE(2): (5'(0� GJ�O�f/O.�_I b FACSIMILE: �r ^� ✓ <br /> TENTATIVE*APPOINTMENT DATE t�M, 12- ­' Tlme; ranYV�R- <br /> (Please allow 10 business days f a a of appllcatlo ubmlttal-'Tsnfativa only-must be confirmed) <br /> (' CHECK BOX TO EXPEDITE REQUa S -$10S FEE( CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSAYS <br /> SIGNATURE OF APPLICANT DATE L 10tizoE5 <br /> Eiectronic Information. ❑ List[] Map—Description: L( i ►1 c- <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City t 1 <br /> 2. Unit2 1/ / <br /> 3. _d 1. <br /> 4. irunlit 3 <br /> 6. <br /> 6. Unit 4 <br /> 7. <br /> t3. ❑ Unit 6 <br /> 9. <br /> 0 Unite- <br /> 10. <br /> nit810. <br /> Specific Date Range of Information Requested. From 3 Z3/­/-_I-�'� T- to /1C(5W <br /> /IM' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )<UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> JR OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL)VC 11 DOG KENNEL O FAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> L7 TIERED PERMITTED FACILITY ❑MOTEL/HOTEL Q PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATT00/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-S: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 deposit prior to review. <br /> EHO USE ONLY <br /> G Gt(.f4t� I i.t i,'✓ dt" <i{c Tom- I I fi ei + r , f e, <br /> if <br /> i v <br /> ui <br /> EHD 48.08 81o4/a8 <br /> PUBLIC REGORDS RELEASE APP FORM <br />