Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> OCT 1. 1 ZYlephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT SERUI ES <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: 2/ (�, i y���uN �T CITY/STATE/ZIP: 7-(f v CA 1- Cly- �S73 8-D <br /> PHONE (1): off' y`3 s- u4t 3 PHONE (2): 2 oq 6 4%- /i s-1 FACSIMILE: <br /> TENTAT/VE*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 (CA)OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT z DATE T <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City E] Unit 1 <br /> I 1' `Z// 2. N C Au yC r�/i --s-- —�oC1�ToN l�1lu ' + J f. G <br /> 2. / b MA �.!jir� %o ��To� _ �. ❑ Unit 2 <br /> `�� gF <br /> t <br /> 3. <br /> 4. Unit 3 <br /> 5. is <br /> 6. eunit 4 <br /> 7. <br /> 8. --- <br /> ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> y ENVIRONMENTAL HEALTH DEPARTMENT FILES `r <br /> ❑'U/t�ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> ❑'OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE , `� <br /> ❑;I�NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY V", 1 <br /> ❑.I� ARDOUS WASTE GENERATO IN ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT to^ <br /> IERED PERMITTED FACILITY- ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOMODY PIERCING ❑POOLISPA ❑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 'mm dJ'ately avaijable for rev'd. : Anew applic t'o�may be <br /> submitted when the file is available. (�� ��� :1:�.,��`, j+ -,-�I - , (1( Z/)I� i' Z- <br /> 1 n.i��,/yt Pp <br /> 4. An file not returned in the same condition as released win be reorVnife�Ci` staf >� s"e bf he v lic nt.� <br /> Y 9 P pp <br /> Future file reviews by the same applicant may require a$125 deposit rior to review. Z0 I e nf- a, �3o/a <br /> {-� EHD USE ONLY 40, J G(/ /) �`� ^ t- ' / <br /> 10-t -Go "i -33 f <br /> I,(S - o/1 <br /> 10-Ig-1 1'- - ►( r 7 � 5 w Uh j apt <br /> EHD 48-065- 10U Cly G—/ld;5i0�1y1'F 3)12 �G�1 �R,c�. I.11?"(f7�6 k5 iA USC' t%j a- Ki—:Ssr r�� <br />