Laserfiche WebLink
15:56:03 08-10-2016 1 /1 <br /> 10, <br /> (11f� _.:0 V E <br /> -DATE RECEIVED EHD LOG NUMBER <br /> - SAN JOAQUIN COUNTY <br /> AUENVIRONMENTAL HEALTH DEPARTMENT <br /> 161 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> R0,`4,r,'E I�ffAL KEALFR' Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SUSIRESSIAGENCY: 9--p's 's ,'I V-0 rl n22� <br /> ADDRESS: C'cr CITYISTATEZP: r4 7— to f <br /> PHONE(1): 224-?RDb X2:0 PHONE(2):H�q-2—',o FAX OR E-MAIL: <br /> ,-er <br /> Please allow 10 business days from date Of application submittal for the records to be available. C�re­,_ <br /> Staff Will contact you to arrange an appointment date and tirne to review the requested records. <br /> ❑ CHECK BOX To EXPEDITE RE U 139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 6U,91( S5 VAYS <br /> SIGNATURE OF APPLICANT / i <br /> 1 3 DATE <br /> 1. 'List up to ten addresses In the'space below. Select the typle-(s)of files from the list below by checking t aphrcpr€_ate <br /> box(es). At least one file type MUST be selected. Fax to(209 464-0136 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of EHO records,please contact EH0 at the number noted above. <br /> 3. The EHD will notify the applicant If arty EH-U 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 rive business days for revlew- Appointments <br /> should be scheduled accordingly. <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 /> 4 Future file reviews by the same applicant may require a$139 deposit prior to review. - I <br /> WELL AND SEPTIC PERMrr. RECORDS <br /> 'ARE AVAILABLE FOR REVIEVy., MONDAY-FRIDAY 8:00 AW5:00PH(F-KCLUDING HOLIDAYS) <br /> Eiecfronic inforniation: El List 0 Map_-Description: <br /> Specific Date Range of Information Requested: From to 0 <br /> ENVIRONMENT <br /> AL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES E Fi D USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) CONSUMER <br /> OTHER CLEANUP Sr(NON-LOP) <br /> HAZARDOUS WASTE <br /> TIERED PERm=FACILITY 2 ❑DAIRY <br /> ABOVEGROUND TANK ct <br /> LIST (MoNrroRiNc I P.EhiovAQ ❑PWS <br /> HAZARDOUS MATERIALS S', <br /> ;KSPLURELEASE RESPONSE <br /> SOLID WASTE FACILrTY/VEHICLELA V 0 WATER QUALQUALITYY <br /> I <br /> ❑FOOD FACILITY Pre& zi g- Al_f�. mAw0 c "' tfi <br /> POOL/SPA Sire MmrAnON <br /> ❑DAIRY <br /> LAND USE ApFrucAnON SITES <br /> ❑SEPTIC PUMPER TRUCK Housm <br /> YAL.Ro/CHEMICAL TOILET-- <br /> ❑WASTEWATER TREATMENT PLANT <br /> ❑HOUSING ABATEMENT 7 irCUPA <br /> Ej MOTEJHOTEL <br /> CHICKEN RANCH I DOG KENNEL <br /> CUPA-UST <br /> F1 MEDICAL WASTE FACILnY <br /> TATTDOIE300Y PIERCING <br /> WASTE TIRE SOLID WArM <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): <br /> A=uNnms <br /> —BOXED AREA-EHD USE ONLY- <br /> 11 Records provided by Staff-PPR Complete. Staff Name: <br /> EHO 48-ZG <br /> Received Tirie Aug, 10. 2016 4: 00PMAo. 1085 <br />