Laserfiche WebLink
11/04/2011 14:33 8&80 PEPS PAGE 01/01 I <br /> RECEIVED <br /> C VES <br /> DATE aFnPivFn SAN JOAQUIN COUI�TIL C 0 P y EHD LOG NUMBER <br /> v U 4. 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH Telephone: <br /> East Main 5t. StoCKton, CA 95202-3029 <br /> PERMIT/SERVICES Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATI N <br /> APPLICANT: 1 " I BUSINESS/AGENCY: r eta <br /> ADDRESS:f0 !/ rramAVeCITY/STATE/ZIP: <br /> PHONE(1): /Sr /p'� � PHONE (2): FACSIMILE �� ' <br /> T TATIVE*APPOINTMENT DATE: Time; <br /> (Please allow 10 bunine»days f tc of oppiioation cubm I "Tonfativo only-muet bo 000firmod) <br /> ❑CHECK BOX TO EXPEDITE REQUES C HO C NLY)-REQUEST PROCESSED IN 3 BUSIN S D S <br /> SIGNATURE OF APPLICANT DATP < <br /> Electronic Information: ❑ List❑ ap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street tt Street Nd e J City Unit 1 <br /> it 0 <br /> 2. Z _—-...` .i �.-&h f !.-1 `) D ---.._ unit z <br /> -- 3. J - , � - '� 1--- - - - -- , <br /> 4. Q <br /> 5. 6lop <br /> fT. Unit 4 <br /> 7. <br /> s J <br /> ❑Unit <br /> 10. W V 'YJ <br /> 6 <br /> Speclflc Data Range of Information Requested: From t0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT OLID WASTE FACILITYNEHIClr <br /> THER CLEANUP SITE(NON-LOP) El Fool)FACILITY ASTE TIRE <br /> NDEROROUNDTANK(MON ITorziNGIR6MOVAL) ❑Doc KGNNIiL litY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PeRMITTEO FACILITY ❑MOTELIHOTEL UMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBODY PII RGING ❑POOLISPA LAND Liar APPLICATION SITED <br /> ElMEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AAM-5:00PM(EXCLUDING HouDAY3) <br /> 1. List up to ten addressg 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 typo MUST be selected. Fax to(209)464-0138 or mailljtcLt4p fit4droag indicated above. Address <br /> ranges will not be accepted-for additional asaiatance with filo addmasca,contact the EHD. Appliontions meeived after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any FHD 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 fives buainvrss days fvr review. Appointitle nls <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 s me applicant may require a$122 deposit priorto review. <br /> 1 E) T�- EHO USE ONLY <br /> A I tit'I � - <br /> EHD 48-08 47129110 <br />