Laserfiche WebLink
MAR-11•-2005 03:56 FROM: 919252948687 TO&40138 P.1/1 � <br /> � ENt}LOG NUMBER <br /> ��� V SAN JoAQr�Irr COUNTY <br /> ►�� BAR app ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> �Hl I[0Iyelephone:(209)468-3420 Fax: (209).464-0138 Web: www.sjgov.org/ebd 571 <br /> 1 ���RM115��VIG�.S <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /�� r� / BUSINESSIAGrE-NNCCY, <br /> ADDRESS: I O�.l eAc-k45,4,k.0/} Cdwl C <br /> PHONE(1 •7'4 � ' _-LJ�i� PHONE(2)c`L FACSIMILE: <br /> 7 <br /> TENTATIVE*APPOINTMENT DATE. &M. Time: 00g <br /> (Please allow 10 business days from date of application submittal_*Tentative only-Must be COMlrmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . DATE 3L,103- <br /> UNIT DISTRIBUTION r3 Unit 1 Un1t 2 nit 3 nit 4 173Unit 6 Unit 6 O Other(alectronlcilistsimeps} <br /> FILE ADDRESS EHD USE ONLY <br /> Street! Stmet Name city <br /> If <br /> V I-L -r I+ 1. / <br /> 2. <br /> 3. � . <br /> A. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> Specific Date Range of Information Requested:From 1 96 d to 4- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -1b UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Q SOLID WASTE FACtUTYNEHICLE <br /> amp <br /> *�s OTHER CLEANUP SITE(NON-LOP) In FOOD FACILITY ❑WASTE TIRE <br /> %1121 UNDERGROUNOTANK(MoNITORINGIREMOVAL) ❑DOG KENNEL 0 DAIRY <br /> "M HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH .�-W WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY a MOTELIHOTEL 0 PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING R POOLJSPA ❑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 Ant-5:00PM - EXCLUDING HOLIDAYS. <br /> 1A <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 Tile type MUST be selected. Fax to(2091464-3138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> AO <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 flies exist, An appointment for review will be confirmed 4� <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. Anew <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 /> ap�pllii�crant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD4"2-006 <br /> 411404 <br />