SU0012814 - Laserfiche WebLink

Home Browse Search

DECEIVED EHD LOG NUMBER ATE RECEIVED " SAN JOAQUIN COUNTY E � `` ENVIRONMENTAL HEALTH DEPARTMENT FEB 14 2013 1868 East Hazelton Avenue, Stockton, CiU.: j Vt1U f Telephone: (209) 468-3420 Fax: (209) 464-0138 W b: jg e F-mvisONMEN TALHEALTH EEFIMfP:3ERb10ES PUBLIC RECORDS RELEASE APPLICATION ( WN t1TV-10av-KP�) APPLICANT:A2'R�.PjI.I.IQ.U,( PR-DPF9nV_S LLt-- KI SINE SIA EN Y: ADDRESS: ✓1/-wD S • BNf cl, T�!60.d CITYISTATEIZIP:__5(a L!j C-lA PHONE (1): ZD%- 4[PL - (v1C iD PHONE (2): FACSIMILE: TENTATIVE*APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST-$1 5 FEE(CASH CH O Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: ❑ List❑ Map—Description: FILE ADDRESS EHD USE ONLY Street# Street Name city ❑ Unit 1 1. •3 774 2- « z2i) T12AC-y 2. 3 Unit 3. 4. ❑ Unit 3 5. 6. ❑ Unit 7. 8. ❑ Unit 5 9. 10. ❑ Unit Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY ❑ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS ❑TIERED PERMITTED FACILITY ❑POOLISPA LAND USE APPLICATION SITES ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) 1. List un to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** Records provided by Staff-PPR Complete. Staff Name: HD 48-06 1914112