Laserfiche WebLink
OL <br />09/26/2011 11:29 510E517 ENL+I-fl PAGE 02/02 <br />DATE RECEIVED 0 EHD LOG NU <br />?PF' <br />/�` SAN JOAQUIN COUNTY <br />�' <br />ECj Vr ENVIRONMENTAL HEALTH DEPARTMENT S"I <br />+ 600 East Main St. Stockton, CA 95202-3029 <br />SEP 2 6 2�1Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENNtaoNMTIs � I��iN ErsVPERM�T ec�vl�(I'r:A1Tt I <br />PERM I ` p , r PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: S�kA�On( kA [CA AND �, IBUSINESSIAGENCY:_k�AVI gD Q _ <br />ADDRESS: WN�(ROU90 E S 3M CITYISTATEIZIP: E A CSS <br />PHONE (1): N_C�) 4W- 2SO3 _ PHONE (2): FACSIMILE: I.O- <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 REQUEST - $125 FEE (CASH OR CIHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT SC n1M i rIaat,c�1t� DATE�2to�.-o„ <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />- El unit <br />Street# <br />Street Name <br />City <br />1. <br />� S <br />Q � 1 l7 <br />( <br />ILAS-1 I ( uy <br />----�kfnit2 <br />2. <br />1f <br />3. <br />Unit 3 <br />4. <br />_ nit4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />nit <br />10, <br />J <br />G <br />Specific Date Range of information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) El HOUSING ABATEMENT OLID WASTE FACILITYNEHICLE �' d <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY WASTE TIRE ry( � I'r <br />IUNDERGROUND TANK(MONITORINGIREMOVAL)V� ❑DOG KENNEL DAIRY I ,211�2��I <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT N l <br />TIERED PERMITTED FACILITY (x ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS <br />TATToo/BODY PIERCING❑ OOLISPA F1 LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑ 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 />FHD USF ONLY <br />EHD 9B-06 Will <br />