Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> ' SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTA1L,-NT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2705 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sigov.org/ehd 2313 <br /> qq PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: !1 RT�-�U R �F I C��t= BUSINESSIAGENCY: j'V0) & c_0 V1'-anw-Y <br /> ADDRESS: 937 s LC W qmd l C V4—,/Y, r; <br /> PHONE(1): oG -I �HCl PHONE(2): FACSIMILE: Z0q'q,b-7-11� q <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 RE EST 3.00 FEEASMOK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S _ �b-a4D6 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 Cl Other(electron!cllists1maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> vjesAr C11�pI'r Y LII) S�-a aR rn <br /> 2. <br /> 3. <br /> 4. <br /> 6. <br /> 5. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From 80 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses, contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> EHD 4M2-006 <br /> 1114105 <br />