Laserfiche WebLink
DATE RECEIVED tnu Lug IvumtltK <br /> (����n nE � ' SAN�TOAQUIN COUNTY — <br /> IS L; U FIVIRONMENTAL HEALTH DEPAhr-l"vIENT <br /> Ia �Q�5 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 U <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> EfvVlnONN ENT HEALTH <br /> PE M11T/SERV19ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ` BUSINESS/AGENCY: <br /> ADDRESS: 2 +� C <br /> PHONE(1):41-7 7 c�� PHONE(2): C_, FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$ 0 EE SH CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION 11 Unit 1 11nit 2 ❑ Unit Unit ❑ Unit 5 ❑ Unit 6 ❑ Other(e ectronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. 5 , -" <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> zg <br /> 0. rI�13 J� <br /> :.. <br /> Specific Date Range of Information Requested: From to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES, <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE �7 <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑� POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ;2yOTHER(PLEASE SPECIFY) M tV)'0, _ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:0OPM - EXCLUDING HO�. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> U c, SSS �v ►�� <br /> r <br /> EHD 48-02-006 <br /> 11/23/04 - t;�' •> <br />