Laserfiche WebLink
To:SJC Page 1 of 1 2009-10-13 1709:54(GMT) 15103720452 From:Tim Loeb <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I[�[►�) 11'� 9 600 East Main St- Stockton, CA 95202-3029 <br /> i—ne: (209)468-3420 Fax: (209)464-0138 Web:www-sjgov.org/ehd YL <br /> C1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: / Q-4 Zoe G� B_USINESS/AGENCY: <br /> ADDRESS: /' 0 �' / c' G CITYISTATEIZIP: <br /> PHONE(1): PHONE(2}: _ FACSIMILE: o `75-Z. <br /> TENTATIVE`APPOINTMENT DATE:_ _ _ Time: _— <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHFCK BOX T-O EXPEDITE REQ ST,$115//FEE(/CASH OR CH:CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT j , P - DATE <br /> Electronic Information: ❑ List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> IT <br /> 4 <br /> 4. - --- - --- -- ----- ------- —— -- �.—_ Unit 3 w <br /> -- <br /> 5. <br /> C 6. nit4 <br /> 7 <br /> Unit 5 <br /> 9 <br /> f 10. OUnit 6 <br /> Specific Date Range of Information Requested_ From _ to _— _.---. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M <br /> _ D,UNDERGROUND TANK(UST)CLf ANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILRYIVEHICLE q <br /> OTHER CLEANUP SITE(KION-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> �T UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY ! <br /> HAZARDOUS WASTE GENERATOR t> CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMNTED FACIL FTY NEOTEIIHOTFI- ❑PUMPFR TRUCKIYARDICHEMICAL TOILETS <br /> "i ❑TATTOOIBODY PIERCING ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILIIY L]OIHER(PLEASE SPLCIf Y) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List urs 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 1209)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 END 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 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHO USE ONLY <br /> i <br /> EHD 48-06 8!27!09 <br /> r ,:: _.r, r ........ ... ....... .. .. <br />