Laserfiche WebLink
OJ—i1 lar lb;1L rtful"1-rU5-rLU1j1llA,LLU, 407-859-9599 T-652 P001/001 F-434 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:wwNv.sjgo /e d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:—,) DV� BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE=(1): L/0'7- 561 ` O_� PHONE(2): FACSIMILE: ill -- O5 " <br /> TENTATIVE*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-$98.00 FEE(CASH O CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: [] List❑ Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 4 Street Name City s t lJ C,9,,-1 6 0� Unit 1 <br /> �^ 2. ❑ Unit 2 <br /> 4 Unit 3 <br /> 5. \/ <br /> --. Unit 4 <br /> fi. <br /> 7' ❑ Unit 5 <br /> 8. -- <br /> 9. <br /> _ ❑ Unit ti <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT Q SOLID WASTE FACILITYNEHICLE <br /> �THER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY 0 WASTE TIRE <br /> NDERGROUNO TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ©CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 11 TIERED PERMITTED FACILITY ❑MOTEL/HOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> d TATTOO/BODY PIERCING 0 POOL/SPA 13 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) _ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9;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 208 464-0138 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 bo 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 same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> 15140 48-06 WEB 802007 <br />