Laserfiche WebLink
DATUN F.—I%eC9 V LZU <br /> SAN JOAQUIN COUNTftUS EHD LOG NUMBER <br /> MAR 2 7 2017 ENVIRONMENTAL HEALTH DEP H <br /> 1: (2 East Hazelton Avenue, Stockton, CA b:www.sjgov.org/ehd <br /> 01Z0110 <br /> i�yVfRQNhEN'fpLFII:AL7}ielephone: (209)468-3420 Fax: (209)464-0138 Web:wwwsjgov.org/ehd J <br /> PEMMITIBERVIICES PUBLIC RECORDS RELEASE APPLICATION <br /> •APPLICANT: 1Shl(Z{ L �(,(dJr BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: 'L <br /> PHONE (1): Cj (] Z 2 PHONE (2): (510) ZZIv -I,P31AX OR E-MAIL: 0 Gb o <br /> Please allow 10 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 /> CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. Select the type(s) of files from the list below 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 flies 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 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 $139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> Specific Date Range of Information Requested: From to _ <br /> ENVIRONMENTAL - --_-� <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) 1 1I p <br /> � <br /> l� 0CGNSUMEP <br /> OTHER CLEANUP SITE(NON-LOP) <br /> HAZARDOUS WASTE <br /> DAIRY <br /> TIERED PERMITTED FACILITY 2 ❑ <br /> I1 ASOVEGROUND TANK 69 <br /> R[UST (MONITORING/REMOVAL) PWS <br /> 51HAZARDOus MATERIALS 0 Y10011" <br /> 'Tl�( SPILUREEASE RESPONSE <br /> WATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> FOOD FACILITY <br /> POOL/SPA <br /> Sere MInGATON <br /> ODAIRY 6 ✓/ " y!/� <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ 6 ❑HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT CUPA <br /> n HOUSING ABATEMENT 7 <br /> F1 MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL 16 CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILIP/ <br /> F1 TATTOO/BODY PIERCING <br /> ❑WASTE TIRE 9 0 SOLID WASTE <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): O ACCOUNTING <br /> 10 <br /> ...BOXED AREA-EHD USE ONLY- <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 46-06 <br />