Laserfiche WebLink
EHD LOG NUMBER SAN .JOA4UlN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t`In 5 ��;� 600 East Main St, Stockton, CA 95202-3029 <br /> Tele hone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.orgle <br /> 3i i Yte <br /> BV140P�MIT HEA LT`� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: J t e(J� �re r`5 BUSINESS/AGENCY: <br /> ADDRESS: 0/ //PSt �e ("-Iew e CITYISTATE/ZIP:� <br /> PHONE(1): PHONE(2): S%O- �/© -J FACSIMILE: j/Q - Z <FX %Y <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days From date of application submittal-•Tenfutfve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHEC LY)-REQUE USINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE_ <br /> Electronic Information: ❑ List❑Map-Descriptio o ✓ a re <br /> FILE ADDRESS EHD USE ONLY <br /> Street Name aunt 1 <br /> � <br /> z <br /> '------ ------ ❑Unit 2 <br /> 3. —.. _......----- <br /> 4 <br /> --- -- -- --- .. .. Unit 3 <br /> 5 <br /> nit 4 <br /> T. <br /> ❑Unit 5 <br /> 9. _ . <br /> 10. <br /> 1 1 ❑Urdt 8 <br /> Specific Date Range of information Requested: Froml fQ 5 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE � f� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY El WASTE TIRE + <br /> UNDERGROUND TANK(MONTTORING/REMOVAt)X El DOG �+' , l <br /> DOG KENNEL n/1• <br /> Eo <br /> l . <br /> HAZARDOUS WASTE GENERATOR <br /> ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELMOTE.L <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑PUMPER TRUCKICA nON SITES TOIL <br /> ❑ MEDICAL WASTE FACILITY El LAND UST.APPLM.ATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uD to ten addresses in the space above. Select the type(s)of flies 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 behold 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$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)465-3425. <br /> FRD USE ONLY <br /> EHD 4846 <br /> 8127M9 <br />