Laserfiche WebLink
11/05/2007 14:38 2133800505 ENVIRONMENTAL PAGE 01/01 <br /> DAT5 {1( D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVMONMENTAL HEALTH DEPARTMENT <br /> NCS O 5 2CC� 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-27 ( rf <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.or <br /> ENV1H SERVICES PUBLIC RECORDS RELEASE APPLICATI <br /> APPLICANT: /nBIUSINESSSIA�GENCY: N I ILL P Y <br /> ADDRESS: 'll7iK'F!/2�i �✓'tID.F SVITFs f��, L.--/--Y-� �Er7(� <br /> PHONE(1): ZIP 3�0^©SSS PHONE(2): FACSIMILE: I - at;i-0 S <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from a_ts of appliciInN. submittal-'Tentative only•must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUES -$9 0 F ASH OR FCK ONLY)-REQUEST PROCESSED 1N 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE f 115 O <br /> Electronlo Information: ❑List❑Map-Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Streets Street Name City ---- -- - - ❑ <br /> 1.. . 9.30_ . 6 Gp+��. V - - 7TOC�7�ry ifW �cvt ( ) Unit <br /> 2. lit.5 T 1 ❑ Una 2 <br /> 3. <br /> p . - -- <br /> Unit y I (J <br /> 6. <br /> 0 <br /> 7. <br /> El unitt; <br /> 3• i <br /> 9. ....__..—._ ❑ units <br /> .. ... ._.. ..-r . . _.._.._. .-- ---- --. .. ..... <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK[UST)CLEANUP SITE(LOP) 0 HOU81NOAUATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> O=CLEANUP SITE(NON-LOP) Q FOOD FACILITY O WASTE TIRE <br /> .w(rU.N_DERGROUND TANK(MONITORINGIREMOVAL) 173 DOG KENNEL DDAIRY <br /> nw.nRDOU9 WASTE GENERATOR Q CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> C1 TIERED PERMITTED FACILITY ❑MOTELIHOTEL 0PUMPER TRUCKIYARNGH,:mTOLETS <br /> 71 TATTOO/BODY PIERCINe O POOLISPA 0 LAND USE APPLICATION SUES <br /> O MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) <br /> WELL ANO SEPTIC PERM"RECORDS ARE AVAILABLE FOR ReviEw- MONDAY-FRIDAY 8:00 AM-6:OOPM • ExcLUPINO HOLIDAYS <br /> 1. List up to ten addresses in the space above. Select the type(g)of files from the list above by checking the appropriate <br /> box(esl. At least one file type MUST be selected. Fax to(209)464-0198 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 /> 1:00 Pm will be processed the next business day, <br /> 2. The END will notBy the applicant if any END 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> 4-7107 uu W .N • GLO ob uct„ <br /> EHo as M'=a <br />