Laserfiche WebLink
U/{It Ktl.tivtu LI1U LU;NUM3EH <br /> SAN JOAQUIN COUNTY <br /> WEDD <br /> E � <br /> N NWON117ENTAL HEALTH DEPARTII)ws�_ ZT <br /> 600 East Main Street, Stockton, CA 95202-2708 <br /> `Nr' I, 2I�007r{tel{/e��'plione: (209) 468-3420 rax: (209)464-0138 Web: w�vw.sjg g h <br /> E!, 11 i1.i��J��:11..14 lEALT'F <br /> 'PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 6 '- BUSINESSIA ENCY: -r'✓�1� /jam <br /> ADDRESS: 1 - <br /> PRONE (1):. 1 2- 1 - ! PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 14 business days from date of appfjcation bmittaf-*Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$9 FEE(CA { OR ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z' v <br /> Electronic Information: ❑ List Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. L _p 00 - �, Unit 2 <br /> 3. _ <br /> 4. <br /> ❑ Unit 3 <br /> 5. <br /> ❑ Unit 4 <br /> 6. <br /> ❑ Unit 5 <br /> $. <br /> 9. <br /> ❑ Unit 6 <br /> 1a. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT fa SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> 171 UNDERGROUND TANK(MONITOR]NGIRE MOVAL) d DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> © TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING 171POOLISPA 9G LAND USE APPLICATION SITES <br /> 0 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(es). At least one file type MUST be selected. Fax to 209 4G4-0138 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 /> =—�►e01D wfl1-A4tify-t6e t-I#any El D files exist:-An-appointment for review-witt-berconfir,, ed apprvximatety ten( -0)- <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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** Ymjhictheraceanserontpr:tone0460 3425 y. Thank *** <br /> EHD 48.06 9!1412006 <br />