Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> 1" SAN JOAQUIN COUNTY 4" <br /> ONMENTAL HEALTH DEPARTMENT <br /> O304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> ' Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: e!Myy \to C�_N91AZ —BUSINESS/AGENCY: APPEOrMU'O, <br /> ADDRESS: <br /> PHONE(1):l 60 8– 0 r)t{ PHONE(2):(A09) 13 a." 0-9 0 D FACSIMILE:Go,)) 3S s <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE R UEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 12.11 q !� <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1N c,K T'OR'N I E us s� H(c.) <br /> rn <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4 a Unit 3 <br /> 5. EMU <br /> n p DEC 5 <br /> 6 ;PoUnit 4 <br /> 7. <br /> ElUnit 5 <br /> 8. ,Y <br /> 9. <br /> ElUnit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES T* <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE f <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 1:1 DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0TIERED PERMITTED FACILITY 1313MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS N <br /> TATTOO/BODY PIERCING ❑POOUSPA 13 LAND USE APPLICATION SITES <br /> El 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. fA it <br /> 1. List up to ten 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 received after <br /> 3:00 pm will be processed the next business day. 0-0 <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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 9/14/2006 <br />