Laserfiche WebLink
DATE RECEIVED EHD LOG NUM R <br /> RECEIVED ENVIRO MENTAL HEALTH DEPARTMENT <br /> FEB 11 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL H( EALTH <br /> aRMI1ICFRVIPUBLIC RECORDS RELEASE APPLICATION <br /> _ ES <br /> APPLICANT: /-ronso 12cr, BUSINESS/AGENCY: jl 1�1�CJlln <br /> ADDRESS: 2v3t(-I Cw'E CrYL CITY/STATE/ZIP: -fore-� CIA 9SZay <br /> PHONE(1): Zo y 1 (4-1 (. 606 PHONE(2): — ( FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE (CASH O ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE ? / I <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ unit 1 <br /> 1. 21/el <br /> 2. ❑ Unit 2 <br /> 4. r <br /> p Unit 3 <br /> 5. /� O!L <br /> 5• 'L lq 2KUnit 4 <br /> $• a<rt C/e �/ ❑units <br /> 9. <br /> 10. ❑ Unit6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILI YNEHICLE <br /> OTOTHER <br /> CLEANUP SITE(NON-LOP) [IHOUSING ABATEMENT ❑WASTETIRE <br /> DERGROUND TANK(MONITORINGIREMOVAL) ElFOOD FACILITY E-1DAIRY <br /> ?TIERED <br /> TANK DOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATERTREATMEtti PLANT <br /> ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY E]POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING )z COMPLAINTJRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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 appro:xImately 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 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$125 deposit prior to review. "*BOXED AREA-EHD USE ONLY"* <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 484)6 914H2 <br />