Laserfiche WebLink
09=24-2010 1 11 <br /> 1234 KLEINFELDER EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> REk"(XV, ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> `lOtO 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENUIRUNI ISE <br /> q0 <br /> P.ERN�! S HEALTH PUBLIC.RECORDS RELEASE APPLICATION <br /> : k�S� <br /> APPLICANT: BUSINESS/AGENCY: FI <br /> ADDRESS: �� 6 _ __ CITYISTTAAjTE/ZIP: �o6<'� C6 <br /> PHONE(1): 511-144 PHONE(2): . QM FACSIMILE: <br /> TENTATIVE*APPOINT DAT Time: <br /> (Please allow 10 business days f date of applic ion submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 1.2 F E(CASH O CHECK O Y)-REQUEST PROCESSED IN 3 BUSINESP DAYS <br /> SIGNATURE OF APPLICANT DATE 9L a <br /> I <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 2. ❑Unit 2 <br /> 3. <br /> r5.4. _Unit 3 nit4 <br /> — <br /> 8. ❑Unit 5 <br /> 9. <br />( 10. <br /> ❑Unit fi <br /> i <br /> Specific Date Range of Information Requested: From to <br />} ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> f <br /> e RGROUND TANK(UST)CLEANUP SITE(LOP). ❑HOUSING ABATEMENT [:1SOL115 WASTE FACIUTYNEHICLE <br /> 1 R CLEANUP SITE(NoN•LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> 3P1TNDERGROUND TANK(MONITORING/REMOVAL) ❑DDG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WAST€GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED-FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING .❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FAcWTY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br />< 4. 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!€ndicated 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 /> y3. 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 /> 4 Future file reviews by the same applicant may require a$122 deposit prior to review. <br />! EHO USE ONLY <br /> 1 <br /> i <br /> J <br /> EHD 48-0fi <br /> 97fOf l0 <br />