Laserfiche WebLink
MAY-28-2009 15:15 Tetra Tech, Inc. 415 974 5914 P.02 <br /> PATE RECEIVED EHD LAG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 EaSt Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209) 468- 0 Fax: (209)4640138 Web:vvww.sjgov.ot <br /> q359 <br /> PUBLI CORD RELEASE APPLICATION <br /> APPLICANT. Y11i 11 SUSINESSIAGENCY: `LA-a <br /> ADDRESS: Iso d 5t �i{+~ 5G Ctty1S>atwop �20M �� <br /> PHONE(1): c5b t " Z Gell PHONE(2): 415 FACSIMILE. 415 X24 '5914 <br /> TENTATIVE"APPOINTMENT DATA --Time: <br /> (Pleas®allow 10 business days from data of appllcatlan submhtal-'TOOM6110 only-must be confirmRd) <br /> M CHECK BOX TO EXPEDITE REQUEST-$1 CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE Of:APPLICANT DATE _ 5 j 24�log <br /> Electronic Information: 0 List❑Map—•Description: <br /> ' FILE ADDRESS <br /> .......... <br /> _. ._..StmetNama _ ......_ I .-- City ❑ Unit1 <br /> Unit 2 <br /> -3. <br /> --- Unit 3 <br /> 4. " <br /> �. unit A <br /> g <br /> I <br /> 7 _........ .- --- ,,,...------.._... Unit s <br /> 8. <br /> g, IUnit6 <br /> 000 <br /> 10. <br /> Specific Date Range of Information Requested:From `�DC _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOu51NG ABATEMENT 14 SOLID WASTE FACILITYlVEHICLE <br /> IK OTHER CLEANIJP SITE(NON-LOP) 0 FOOD FACILITY Iffi.WASTE TIIM <br /> X UNDERGROUND TANK(MOHITORINWREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ,SL HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH A WASTEWATER TRCATMCNT PLANT <br /> TIERED PFAMITTEO FACRJ-N Cl MOTFAJH*vr;L 0 PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING In POGUSPA K LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND$OPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-mowAv-Fp14AY 9:00 AM-5:00PM -EXCWUgNO f IOLIPAYS. <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax 19(2()s)464-0138 gr mail to the address inicated above-_ Address <br /> ranges WUI 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 FiHo 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 /> 3. A f9e 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 some condition as released Wit be reorganized by EHD staff at the expense of the applicant- <br /> Future Me reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD iW6 5104108 PUBUG RECORDS RELEASE APP FORM <br /> TOTAL P.02 <br />