Laserfiche WebLink
868VED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT ! m <br /> SEP`3 0 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 201 r <br /> elephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH �� A <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION ►�� �'- <br /> i ).l <br /> APPLICANT:c-' BUSINESS/AGENCY: <br /> ADDRESS: 7�� 7 ( { ���f CITY/STATE2IP: <br /> PHONE (1): 55c? E,57.(77_ PHONE (2):_5 .320. 62 FACSIMILE:_, �_ <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- V5 FE (CASH O HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICA DATE 1a0 <br /> Electronic Information: ❑ List❑Map-Descriptidn': <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 19 f•-Q Unit 1 ' <br /> 00SIT11 Ill ZD W <br /> 2. <br /> 3. �O Y � "Unit 2 <br /> 4. <br /> _(%]Unit 3 <br /> 5. - <br /> s, 11 <br /> ©-unit 4 <br /> 7. <br /> 9 ❑Flnit 5 <br /> 10. <br /> ,.[��Unit 6• <br /> Specific Date Range of Information Requested. From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES UtI1 I <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [1 MEDICAL WASTE FACILITY SOLID WASTE FACILRYIVEHICLE I�1 I <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT 29-WASTETIRE („rliJ <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ®DAIRY l cc V b l,t�L',O v� <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT Cj>,2 0(5,). <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYA0ICHEMICALTOiLETS j <br /> TIERED PERMITTED FACILITY ElElPOOLISPA LAND USE APPLICATION SITES 16 <br /> TATTOOIBODY PIERCING X COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) lk <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(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 fora 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 priorto review, s.:._., OXED,AREA>:FHD FIs) ON1�YI <br /> _ <br /> �. <br /> - - <br /> .ri - - <br /> ..... . ... . <br /> �ro 40.as .,.... <br /> 914112 <br /> eceived Time Sep. 30: 2013 7:48AM No, 4171 <br />