Laserfiche WebLink
DATE RECEIVED <br /> ® �� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> R ENVIRONMENTAL HEALTH DEPARTMENT 1 _ <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> MAR 26 2012 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> EWpEp jTEI4TALHEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> r <br /> APPLICANT: W0d Coyaf'- BUSINESS/AGENCY: TICS/ <br /> y <br /> ,SIV <br /> ADDRESS: �Z � /1/chyy L)tI S Ck'-ky CITYISTATE/ZIP:C/' C25zQG <br /> PHONE (1): 2011-YG6-7737 PHONE (2):_ZO� CJ&C `/5_L1() FACSIMILE:ZOJ yely117c9U <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date')'application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST,- 125 FE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `�� ��A DATE '3-2 - j Z <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street k Street Name city <br /> 2. 4kW yam/ <br /> El Unit 1 <br /> 3. - ❑ Unit 2 <br /> 4. <br /> 5. <br /> Unit 3 <br /> 6. (� <br /> 7 Unit 4 <br /> 8. <br /> g — ❑ Unit 5 <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK UST CLEANUP SITE LOP ❑SOLID WASTE FACILITYNEHICLE <br /> (UST) (LOP) ❑HOUSING ABATEMENT <br /> OTHER CLEANUP SITE NON-LOP ❑WASTE TIRE ' y <br /> ( J El FACILITY <br /> UNDERGROUND TANK MONITORING/REMOVAL d� ❑DAIRY <br /> ( ) ❑DOG KENNEL ?�(yI <br /> 1;1�_ � LI WASTE GENERATOR CHICKEN RANCH <br /> IERED PERMITTED FACILIT ❑WASTEWATER TREATMENT PLANT <br /> 1O�' ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <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. <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 $125 deposit prior to review. <br /> -IZ: s tDOOD <br /> EHD 4B-8fi <br /> 8/1/11 <br />