Laserfiche WebLink
1 213 12:25:47 03-21-2016 1 <br /> EHD LOG NUMBER <br /> CA' SAN JOAQU[N COUNTY <br /> k rE ENVRONMENTAL HEALTH DEPARTMENT <br /> 186B East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ITP Mle: (209) 468-3420 Fax., (209) 464-0138 VVeb* mw,1.sjgov.org1Ed <br /> PE R M� IT,tSEFZV/TCE0 C p <br /> 11USUC RECORDS RELEASE APPUCAT[011 V ILI <br /> APP/ [CANT: t lt-s cl- S BUSINESSIAGENCY: -T��GL- <br /> ADDRESS: CITYISTATEIZIP: Air) AV--bc)r, N( `tains <br /> PHONIE(i): 72,4-Z 14 CY, I PHONE(2): FAX CR E-ViAlL.- I e 5 a— 3,61 ed—a <br /> Please allow 0 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records, <br /> El CHE0 KEldTO:EXPE-.Q-lT5.R1E9-QEST- 100 FEE LCASH.09 CHtQK ONLY); FEQ-QE-.ST PR0055SEP a14-3'Busl <br /> NE88CDAY8 <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: El List E] Map—Descriptlon: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street 9 Street Name City <br /> L-J <br /> 2. Z 9 ?2 <br /> A,/ <br /> 3. (9-61 It 2 <br /> 4. ED UnIt 2H <br /> 5. <br /> 2-0n.I t 3 H MI <br /> 7. El Unit 4 <br /> 171CITW mrrinATirwi <br /> 9. <br /> 1�4 'Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> FZJ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) F-1 MOTELIHOTEL F-1 SOLID WASTE FACILITY[VEHICLE <br /> MOTHER CLEANUP SITE(ft-LOP) D HousiNo ABATEMENT El FOOD FACILITY <br /> R UNDERGROUND TANK(MONITORINGIREMOVAL) EJVVASTE TIRE El DAIRY,POOLJSPA <br /> Fq ABOVE-GROUND TANK F CHICKEN RANCH/DOG KENNEL F71 WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE El MEDICAL WASTE FACILITY [❑71 PUMPER TRUCKNARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS 0 TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY 2COMPLAINTIRESPONSE RECORDS D OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00Am-5:00pim(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.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 /> 4. Any Me not returned in the same condl6on as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future Me reviews-by the same applicant may require a$130 deposit prior to review. <br /> "*BOXED AREA -EHD USE ONLY"* <br /> El Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Maf. 21, 2016 9 : 23AM No- 0602 <br />