Laserfiche WebLink
EHD LOG NUMBER ,y <br />DATE RECEIVED SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 �` v <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: / IPc� BUSINESSIAGENCY:9 o7Q J <br />ADDRESS: 51V0 O(/ P/ r CITYISTATEIZIP: �y'�c9� <br />PHONE (1): ?Of Cl�� �i _ PHONE (2): Z&i 7119Y4,�re 6 FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only -must be confirmed) <br />❑. CHECK BOX TO EXPEDITE ES - 125 FEE (CASH QRICRWK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE /O1/%!✓ <br />Electronic Information: ❑ List ❑ Map—Description: <br />] UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />❑ FOOD FACILITY <br />E <br />Street # <br />Street Name <br />City <br />1. <br />&ERED PERMITTED FACILITY <br />r. <br />TATTOO/BODY PIERCING <br />❑ Unit 2 <br />2 <br />❑ COMPLAINT RECORDS <br />R9 <br />�l�fFI011�� <br />3. <br />❑ Unit <br />4 <br />5. <br />❑ Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />$ <br />9. <br />❑ Unit 6 <br />10 <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />] UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT E <br />E <br />] OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />E <br />] UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />E <br />M�HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />C <br />&ERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />C <br />TATTOO/BODY PIERCING <br />❑ POOLISPA <br />E <br />MEDICAL WASTE FACILITY <br />❑ COMPLAINT RECORDS <br />SOLID WASTE FACILFFYNEHICLE <br />WASTETIRE <br />DAIRY <br />PUMPER TRUCKIYARDICHEMICAL TOILETS <br />LAND USE APPLICATION SITES <br />OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. List up to ten addresses in the space above. Select the types) 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. <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 />r..- -_..:_..._ .,.�_ _...,,..,. u. ..* may ranuire a $125 deoosit prior to review. <br />EHD 48-e6 <br />�� � ' G!� • <br />. ► IaIsL-ii <br />/ � iL. � / 111. 1 /� � �.1L_/% <br />r 1 �dI t l- <br />R9 <br />�l�fFI011�� <br />EHD 48-e6 <br />