Laserfiche WebLink
08/14/2007 17:47 9494293 ESS 40 PAGE 02 <br /> DATE R90EIVEp SA,N-JoAQUIN COUNTY EFID LOG NUMBER <br /> W LS� V�� <br /> �f V E+NVIRONMENTAL HEALTH DEPARTMEN <br /> 304 East Weber Avenue, 3"t Floor, Stockton, CA 95202- <br /> A <br /> AI1Gj 0 2007 Telephone: (209)468-3420 Fax: (209)464-01.38 Web: www.sjgov. /- <br /> ENVIRONh9E >t'LSLIC RECORDS RELEASE APPLICA ON <br /> APWW 1_-Q.��.�po BUSINESS/AGENCY; ::::rnnl>,swi��_,2Cf'Y/cSS' <br /> ADDRESS: <br /> PHONE(1): 0_449,) PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tantadve only-must he confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-wxa FEE(CASH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� 9 Z Lie DATE .&4YIQ7 _ <br /> UNIT DISTRIBUTION ❑Unit 1 Fl Unit 2 ❑ Unit 3 M Unit 4 ❑Unit 5 O Units ❑ Mar(aiactmnidilsm/maps) <br /> FILE ADDRESS _ <br /> - ---. <br /> - — <br /> 1y"0 .,--,--, Serest N SlTast Name r .. ._.._T— .. City _._-_. EHD USE ONLY <br /> n � Y� <br /> kol� yy. 3. - — - - <br /> 7 - - <br /> Specific Date Range of Information Requested' From to <br /> �\� \ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> f1NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING AEATEMENT ❑SOLID WASTE FACILRYNEHICLE <br /> [$1 j7` THER CLEANUPSnE(NON.LOP) Q FOOD FACILITY 4 WASTE TIRE <br /> KUNOERGRCUNO TANK(MONITOWNWREMOVAL) U DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTPLIHOTEL 0 PUMPER TRUCKIYARD/CNEtl TOILETS <br /> 0 TATT0018ODY PIERCING U POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FDR REVIEW. MONDAY-FRIDAY 6:00 AM-5:00PM _ EXCLUDING HOUDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(S)Of files from the list above by checking the <br /> appropriate box(es)- At least one file type MUST be Selected, Fax to f209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD tiles exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file is available. <br /> 4, Any file not returned in the some condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the some applicant may require a$93.00 deposit prior to review. <br /> ERP 4"2-006 <br /> 1/1dN5 <br />