Laserfiche WebLink
NOV-4-2009 11:44A FROM:GEOPHF ENV 2095690295 - 4640138 P.2 <br /> �./ 1./ <br /> --'-^-DATE RECEIVED tE LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> go 600 East Main Street, Stockton, CA 95202-3029 <br /> Nov 0 4 2009 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> ENVIRON PUBLIC R CORDS RELEASE APPLICATION <br /> Y <br /> PE �1�u/II c e �M P BUSINESS/AGENCYirey <br /> ADDRESS: b�--/ ?7y 1 K ti�4„ CIIy1stateIZIP tiltz <br /> PHONE(1): SjO PHONE(2'):' <br /> �5f rH OIC 9FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: //I0 /;!�0 Time: <br /> (Please allow 10---loess days from ato of appli atlon submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REOUE T-$105 FEE( ASH OR CHECK 0 LY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _t DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Name _ City Unit 1 <br /> V —_ - <br /> 1' <br /> 2. __ _. ❑ Unit �1 '1)3 <br /> 3.- <br /> _. __ __. . nit 3 <br /> 4. <br /> 5• Unit4 <br /> 6. <br /> 8. -_ _ _. -. ❑ UnIl6 <br /> 9, ❑ Unite <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> /ONDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY WASTE TIRE <br /> �DERGROUND TANK(MONITORINGIREMOVALV� ODOG KENNEL DAIRY (/tA ' <br /> HA�ZARDOUS WASTE GENERATOR01 ,L,\ ❑CHICKEN RANCH d WASTEWATER TREATMENT PLANT I( <br /> ❑TIERED PERMITTED FACILITY 13 MOTEL/HOTEL E3 PUMPER TRUCK/VARD/CHEM TOILETS (/)/,EI/0 <br /> O TATTOO/BODY PIERCING O POOLISPA O LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9:00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to len 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 recelved atter <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 /> EHD USE ONLY <br /> RM <br /> EHD 48A6 8104/08 PUBLIC RECORDS RELEASE APP FO <br />