Laserfiche WebLink
Jun 30 09 01 : 02p Kraz & Rssociates 559348 '0 p• 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> jN 'I NO Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org <br /> 4 7 L <br /> !'V', ftt PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY: <br /> ADDRESS: c?i S fes• 0�+�{� \ f���• CitylState/Zip <br /> PHONE(1) PHONE(2): FACSIMILE: ($S-1 r ` <br /> TENTATIVE`APPOINTMENT DATE: � Time: i .00 rM <br /> (Please allow 10 business days from ate of application submittal-"Tentative only-must be confirm <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 1JF AYSS <br /> SIGNATURE OF APPLICANT DATE L <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY _ <br /> Street# Street Name City <br /> 2. 11 °./ 000 lam' unit 4. <br /> 4. nit 3 <br /> 5. - <br /> - - Unit 4 <br /> 6. <br /> 7. 9N4, ❑ Unit 5 <br /> 8. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑ POOL/SPA LAND USE APPLICATION SITES <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(es). 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 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 $105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 804`08 - aI JBLIC RECORDS RELEASE APP FORM <br />