Laserfiche WebLink
EHD LOG NUMBER <br /> ° � il�lr SAN JOAQUIN COUNTY <br /> LTH DEPARTM N'T <br /> ENMONMFNI-AL HEA <br /> ��� I I GU 600 East Main St. Stockton, CA 95202-2708 <br /> ele��houe: (209) 468-3420 Fax: (209) 464-0138 Web: NVwW.Sjgov.o <br /> F;dtiJ�r�,�1�`��E�`4i'HEAL ,J <br /> APPLICATION <br /> PE .JlS,ERV110 S PUBLIC RECORDS RELEASE p <br /> APPLICANT: ., BUSINESSIAGENCY: 7l� <br /> 4-eADDRESS: I• L �j� 7�- rl;7% <br /> �� C� <br /> PHONE(1): I ��' PHONE(2): FACSIMILEt <br /> r � z <br /> TENTATIVE"APPOINTMENT DATE: 3`� �CJcF Time: j <br /> (Please allow 10 business days from date of application submittal J n`fa ly-must be confirmed) <br /> t r � <br /> CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH OR CHECK.ONLY)-REtsll5 OCESSITD lN'3 BUSINESS DAY5 <br /> SIGNATURE OF APPLICANT ' DATE, <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> ...FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> /10't Unit 2 <br /> 2- <br /> 3. <br /> 3. ;eUnit 3. <br /> 5. Zy Unit 4 <br /> El unit 5 <br /> r r <br /> q Sof <br /> 9..: � -� .:J.- .�.rr'� S f Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> II ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> i. UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMEN _ SOLID WASTE FAGILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) <br /> FOOD FACILITY ' RY` WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) M DOG KEN ��` M DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ C C rp WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY � M <br /> PUMPER TRUCKIYARDICHEMTOILETS <br /> 0 TATTOO/BODY PIERCING ❑PO P LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑ OTH R(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE.FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:60PM - 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 clays 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 $115.00 deposit prior to review. <br /> f <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez (209)46$-3425 directly. Thank You*** <br /> E <br /> 8l91120D9 <br /> FNf]48-06 - - <br />