Laserfiche WebLink
Nov 28 05 03:26p Apex 2(' '67-9668 p.1 <br /> L SAN JOAQUIN COUNTY F3-0 LOG NUMBER_ C� E <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor,Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0T38 Web: www.sjgov.org/ehd 0,3 <br /> "T HEALTH <br /> =WCES PUBLIC RECORDS RELEASE APPLICATION <br /> Vt_ <br /> APPLICANT: f`b+f a►n 11�w <br /> BUSINESS/AGENCY: <br /> ADDRESS:- Zfo I-►ice t j�.FI v- -ro r 1-0 C k <br /> PHONE(1): c.V —b'G�*t PHOW(2): FACSWII E_ 116 �0- 9 6 b <br /> TENTATIVE*APPOINTMENT DATE (Z ! .'. 011 l� <br /> (PIS allow 10 business days from data of application submittal-'Tm aSve only-must be coaflrtneo <br /> C1 CHECK BOX To EXPEDITE REQUEST-$93.00 FaEEGASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 USI DAYS <br /> SIGNATURE OF APPLICANT D/ -U*- --✓ ` DATE !171 C3 <br /> UNIT DISTRIBUTION ❑Unit 1 ❑ Unit 2 D Unit 3• Unit 4 ❑ UNt 5 ❑ Unit 6 ❑ Odw(electronicrosWrnapa) <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 street Name city <br /> 2 O L l4. L%01A. S i.,.c. -+ �( 1161 <br /> I re s <br /> tv_ n <br /> 6. (4CAS a _ _ - tt C X17 �_0 /�9 <br /> 1,0 8. — <br /> . '141 <br /> 3A r f <br /> 10. S. D4 $ 7tq <br /> Specific Date Range of information Requested: From to <br /> �J- ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Wt 1rWCRwwuND TANK(VST)CLEANUP SITE(LOP) ❑HOUsIHG Aal1TEMENT 0 3mx WASTE FACRITY(1(EMCLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACiITY ❑WASTE TWE <br /> C3 UNDEFb=OUND TANK(MoNrrotlNorREmoyAL) ❑DOG KENM3- 0 DAIRY <br /> ❑HAzARaous WASTE GENErtATDR ❑CHraceN RANCH o wAsTEwATER TnrATMENT PLANT <br /> ❑Tomm PERmnmx)FAauTv 0 MOTELIHOTEL ❑PUMPER TRUCKIYARofC1iEM Touzm <br /> ❑TATTOOMODY PW.MNG ❑POOLISPA ❑LAND USE APPLICATION SITE3 <br /> ❑Nu EUCAL WASTE FACILITY ❑OTHER(PLEASE SP£Cnj <br /> WELL AND SWnC PERP n RECORDS ARE AVAILABLE FOR REVIEW- MmDAY-FRIDAY 8:00 Ah":OOPM - EXCLUDING HOLZAYS. <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 apprrcant 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 /> EUD 49-M-006 <br /> 1114M5 <br />