Laserfiche WebLink
RECEIVED M <br /> DATE RECEIVED 40• EHD LOG NUMBER <br /> FEB 2 3 2012 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 600 East Main St. Stockton, CA 95202-3029 <br /> PERMITISERVICES Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> rr PUBLIC R CORDS RELEASE APPLICATION <br /> APPLICANT: fr_Uy-i YL BUSINESSIAGENCY: ( ;c Env;tirom�n <br /> ADDRESS. 3x55 W-'hA ; re 131✓d T1) CITYISTATE/ZIP:^ LL5,7, Ana,P1t2� .(A ) -IAA <br /> 'DZ <br /> PHONE(1): �I3•-JSd-QO�n PHONE(2) - . . _ _ _ - FACSIMILE: �..� <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-*Tentative only-must be Confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$12,2 FEE 'CASH O CHECK ONLY)-REQUEST PROCESSED IN 3 B SINE 5 DAYS <br /> SIGNATURE OF APPLICANT � / DATE 2 ? 2 2a L <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit <br /> 1. aLOA, ro <br /> 2. <br /> bL ❑Unit 2 <br /> 3. <br /> 4• O.Unig2 <br /> 5. fFl2 c/LCuho J <br /> 6. <br /> c,L,✓ F nit A 2 <br /> 7. <br /> 8. ❑Units <br /> 9. <br /> 10. ❑Unit. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON•LOP) [I FOOD FACILITY ASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) El DOG KENNEL [I DAIRY <br /> AZARDOUS WASTE GENERATOR E]CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEIJHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTDOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SRES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. 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(as). Al least one file type MUST be selected. Fax to 12091 4840138 or mail to the address indicated 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 /> 3. 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 /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 46-06 07129110 <br />