Laserfiche WebLink
DATE RECEIVED <br />ENVSAN JOAQUIN COUNTY EHD LOG NUMBER <br />IRONMENTAL HEALTH. DEPARTMENT <br />600 East Main St. Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjg io <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: � �"--t+- _ � BUSINESSIAGENCY: <br />ADDRESS:-__�C-j Qx'-j',r y(,(2 _� CITY/STATEIZIP: <br />PHONE (1): �y �S-yL-�iZ� PHONE (2):FACSIMILE:Z <br />TENTATIVE* APPOINTMENT DATE:" Time: <br />(Please allow -10 business days from date of applicatiorf submittal -'Tentative only =must be confirmed) <br />CHECK BOX TO EXPEDITE REQUEST - $115.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT -'+h-- DATE, <br />Electronic Information: ❑ List ❑ Map - DescriptioV <br />. <br />• � II <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ unit <br />❑ Unit 2 <br />Street # <br />Street Name <br />City <br />2. <br />3. <br />❑ Unit 3 <br />4. <br />5. <br />nit 4 <br />G. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />A <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH .DEPARTMENT FILES. <br />5p'IERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILrrYNEHICLE <br />OEER CLEANUP SITE (NoN-LOP) ElFOOD FACILITY ❑ UNDERGROUND TANK (MONITORINGIREMOVAL) El DOG KENNEL ❑ WARTE'TIRE HAZARDOUS WASTE GENERATOR DAIRY <br />❑ CHICKEN RANGH ❑WASTEWATER TREATMENT PLANT <br />❑ TIEREDPERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS <br />❑ TATTOOBODY PIERCING ❑ POOLISPA. <br />F] MEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <br />❑ 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((?s). At least one file type MUST be selected. Fax to 209 464-0138 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 END 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 $115.00 deposit:prior to review. <br />***if you need further assistance please <br />PWn ARA% - <br />EHD USE ONLY <br />Diane Martinez directly @ (209)468-3425. Thank You*** <br />