Laserfiche WebLink
UL/1,D/LUUa 11.JO 1D10.n rz)orUl bLFAUK,t5UKN L UN4DUL I iNO tIAlaL Ul <br /> 0 16 EHD i_OG NUMBER <br /> ��� " �'=� SAN .�i�AC�UIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 13 600 East Main Street, Stockton, CA 95202-3029 41 6 <br /> i` ���Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgleh <br /> EkVVIRONMEN T,iEAI.TH <br /> �il�` � _�'�14�F'� PUBLIC RECORDS RELEASE APPLICATION <br /> APPL1CANT: <br /> .,,,r,tl /n�I r,�. susiNE33rgfENCY: L /�t�j <br /> *' .� al � ,QFE7r City(stutor <br /> zip <br /> ADDRESS: <br /> �^Y .�..�..„ �� ... <br /> ��6 -� 3�yy ,5 ,�� PHONE(z►: FACSIMILE: 7 <br /> PHONE(1): v_r�_-3,[tea,�tL�— <br /> TENTATIVE"APPOINTMENT DAT : ��.3 __ Time:_10 G� ., <br /> (Please allow 10 business days from date of app Icativn suhmfttal-•Tanterlva only•mwst be confirmed) <br /> 171 CHECK BOX TQ EXPEDITE REQUEST-$105 FEE(CASH CTR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List d Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A 8treat Name Q E] Unit 1 <br /> 1. <br /> _,e E13 9 41 <br /> KC <br /> 3. , 4 R.o, ht��tlJ I� �� y . lJnit 23. A_ _. .,. 21 <br /> nit 3 <br /> - _ -_ <br /> Io�SNo�'S .. <br /> V B_ <br /> 7. Il unit 6 <br /> El Unita <br /> 10. <br /> Specific late Range of information Requested: From Z 95 to Pg Ese <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> • UNDLRGROUNTANK(tJ9T)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT 171.50LID WASTE FACILITYNENICLr: <br /> t) <br /> •OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY C3 YYASTE T1Re <br /> •UNDERQROUNo TANK(MONITORINOIREMOVM-) 0 DOG KENNEL ❑DAIRY �' �f I�,• 4� <br /> • HAZARDOUS WASTE C3F%tRATOR Oel 171 CHICKEN RANCH d WASTEWATER TREATMENT PLANT V [J[ <br /> •TMRED PERMITTF.1?FACII.,$TY C7 MOTELIHOTEL 0 PVMP'>FR TRUCKfYARDICNEM TOILETS <br /> r3 TATTOO#SOnY PIERCING 0 POOUSPA w LAND USE APPLICATION SITES <br /> 0 MEI}ICAL WASTF FACIi..ITY ❑QTHFR(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW . <br /> MONDAY-FRIDAY$:00 AM-G:OI�PM EXCLUDING HbLIDAYS, <br /> 1. List up to ten addresses In the space above. Select the type(a)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, fax it f209)404-0138 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 EHb will notify the appilcant 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 flte reviews by the same applicant may require a$1015 deposit prior to review. <br /> EHGI USE ONLY <br /> 5 S051 _q_ D 011 ` <br /> AHC]a9.Ofi BlpA10R~ PUBLIC RE rORDS RELEASI=APP FORM <br />