Laserfiche WebLink
NOV-17-2010 WED 02:26 PH FAX NO, P. 01 <br /> EHO LOG NUMBER <br /> I RECENED SAN JOAQUIN COUNTY � "7 � 103ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 17 2010 600 East Main Street, $tockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 FHx: (209) 464-0138 Web: www,sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SER �° __tO6S a3L LLF <br /> BUSINESSIAGENCY: ✓r <br /> APPLICANT: lenren "- <br /> ADDRESS: _ SO F� OZ'S 20y�F/d0/ _._ Cltylstata2lp Son ��" ncl«o� CA 9v/e.S <br /> PHONE IIP Cr'/J� 59/-7S7Z PHONE(2): C4/S_I S9/'�SOO FACSIMILE: CylSJ 59/ "7rly <br /> TENTATIVE'APPOINTMENT DATE: <br /> Time: <br /> (Please allow 10 bealness days from da,dappllr.atlon submidal• T6,taeve only-must be confirmed) <br /> CHECK 80X TO EXPEDITE REQUEST• <br /> $105 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE I I^ ) <br /> SIGN-:ITURE OF APPLICANT -- <br /> Electronic Information: []List❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name - CIV U I <br /> 1. $00 LJeS> C� rc� Screed S�aCEfDn — 7 <br /> ❑ Bnn 2 <br /> 2. <br /> 3. Unlf3 <br /> a. <br /> Unit 4 <br /> Unit 5 <br /> 7. -- '–' <br /> &. <br /> - ❑ units <br /> 8. <br /> 10. RCSe Fou dafe <br /> 0 <br /> Specific Pate Range of Information Requested:From �3� � 2�� to Ph o r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES mques+s> <br /> HOUSING ABATEMENT [3 SOLID WASTE FACILITYNEHICLE <br /> NDERGROUND TANK(VST)GLEANUP SITE(LOP) M voOO FACILITY O WASTE TIRE <br /> HER CLEANUP SITE(NON-LOP) C3 OOG KENNEL ❑DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOYAL� ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTE GENERATOPG�- ❑Ot7 MOTEij RANCH <br /> raCKEN10TEl IM PUMPER TRUCN/YARPICHEM TOILETS <br /> •TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPUCATION SITES <br /> •TATTOO/BODY PIERCING O OTHER(PLEASE SPECIFY) <br /> •MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC;PERMIT RECORDS ARE AVAILAeI.6 Foa RI vlew -MONDAY-FRIPAY 8:00 AM•S;OOPM • EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Sehlct the Iype(s)of files from the list above by checking the appropriate <br /> ess <br /> box(as). At least one file PefarfadditionalST esselected. <br /> e Glance with file addresses,contact the HDS Applications received arner <br /> ranges will not be accepted <br /> 3:00 pm will be processed the next business day- <br /> 2, The EHP will notify the applicant if any EHID 0105 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 stuff may not be Immediately available for review. Anew application may be <br /> submitted when the file Is available. applicant. <br /> 4. Any file not returned in filo same condition as released will be reorganized by EHD staff at the expense of the <br /> Future 010 reviews by the Sams applicant may rel lulre a$105 deposit prior to review. <br /> EHI I USE ONLY <br /> e. <br /> p - <br /> ___ PUBLIC RECORDS RELEASE APP FORM <br /> EHD 4646 8104/06 <br />