COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

DATE RECEIVED 0 EHD LOG NUMBER SAN aIOAQUIN COUNTY E( C V1 D ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 FEB 2 5 2013 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd ` w ENVIRONMENTALHEALTH PUBLIC RECORDS RELEASE APPLICATION - APPLICANT: �-j y % BUSINESS/AGENCY: �/ ADDRESS: �S CITYISTATE/ZIP: 6z-41zotm �✓ g5 � PHONE (1) PHONE (2): FACSIMILE:&Y� 7(0®' 03 T NTATIVE*APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) ❑ CHECK BOX TO EXPEDITE REQU ST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: ❑ Li ❑ —Description: FILE ADDRESS EHD USE ONLY I/ Street# Street Name city ❑ Unit 1 1l. 1. �7� ,I d � �� 2• �— L/',+7/N b ❑ Unit 2 3. 7> 4. p Unit 3 5. 6. ❑'Unit 4 7. 8. ❑unit s 9. 10. ❑Unit 6 Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACI %T7IVEJiICL6 TJ ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE - )1� `�Q f ) J'• US NDERGROUND TANK(MONITORINGIREMOVALCK ❑FOOD FACILITY ❑DAIRY r BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT _5_a- 13 . ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. .3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$125 deposit prior to review. *'*BOXED AREA-EHD USE ONLY*** ❑ Records provided by Staff-PPR Complete. Staff Name: EHD48-06 914112