Laserfiche WebLink
AUG-6-2909 11:16A FROM:GEOPHASE;ENU 2095690295 IT0:4683433 P.2 <br /> ,. <br /> (4 k 1N <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH' DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd <br /> T . <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'f f& BUSINESS/AGENCY:6;90G/ <br /> ADDRESS: G <br /> Cityl5taterZlp Atfdoee CL 70 <br /> PHONE(1): f ,— PHONE(2): FACSIMILE:- <br /> TENTATIVE"APPOINTMENT DATE: a Time: <br /> (Please allow 10 business days from date of application submittal-•Ten(ative only-must be conRrmed) <br /> © CHECK BOX TO EXPEDITE REQUEST-$108 FEE(CA H OR CHECK ON Y)•REQUEST PROCESSED IN 3 B INESS DAYS <br /> SIGNATURE OF APPLICANT DATE � G <br /> I <br /> Electronic Information: ❑ List❑ Map—Description: 3; € <br /> FILE ADDRESS I EHD USE ONLY <br /> Street# Street Name CI --- -_ . ....-_._. — _ <br /> ------- © Unit 1 <br /> 2- ❑ Unit 2 <br /> ❑ Unit 3 <br /> 4. <br /> ❑ Unit 4 <br /> 0 Unit <br /> 8. <br /> 9. _.. x ... ❑ Unit6 <br /> j 10. x . <br /> Specific Date Range of Information Requested: From to. <br /> A. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> Q OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ' C3 WASTE TIRE <br /> C3 UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> CT TIERED PERMITTED FACILITY 0 MOTELlHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOWBODY PIERCING O POOLISPA E3 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL ANDSEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am 6:00PU - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fist above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12091464-0138 or mall to tFi'e address Ingi-cated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EMD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant If any EHD flies 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 /> I <br /> should be scheduled accordingly_ i <br /> r 3. A file that is actively being worked on by EMD staff may not be immediately available for review. A new application may be <br /> I submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EMD staff at the expense of the applicant- <br /> Future file reviews by the same applicant may require a$106 deposit prior.to review.. <br /> EHD USE ONLY <br /> EHD 48.06 0104108 PUBLIC RECORDS RELEASE APP FORM <br /> s <br />