Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> V Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: {/hskh (?�vi, BUSINESS/AGENCY: prA F�,riFov.w�e.c+(,zOt lHa- <br /> ADDRESS: 3-4(oo Qau�tat -B)vet Ste- foo CITY/STATE/ZIP: <br /> PHONE(1): Col) gLks_ 3-I-Ig PHONE(2): (Tje�> Zzk-34-tp FACSIMILE: -(A <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /�.�.-!�`t-- DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name city - Unit 1 <br /> 1. to <br /> 2. lel I 'W C11 nit2 <br /> 3. 1tSo ( ( <br /> 4. -16p 1`IN11� Q'Unit3 <br /> 5. I dost <br /> 6. El U it 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> �unit s <br /> Specific Date Range of Information Requested: From I qao to -proe k <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> B NDERGROUND TANK(UST)CLEANUP SITE(LOP) DVEDICAL WASTE FACILITY [SOLID WASTE FACILITYIVEHICLE <br /> L�vTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT 2*ASTE TIRE <br /> HVNDERGROUND TANK(MONITORING/REMOVAL) ❑FQOD FAC1LrrY [a"�AIRY <br /> D-KBOVEGROUND TANK HICKEN RANCH/DOG KENNEL 9 WASTEWATER TREATMENT PLANT <br /> O-WAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL g-PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> DIIERED PERMITTED FACILITY 21001ISPA [LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING Q'COMPLAINT/RESPONSE RECORDS ['OTHER(PLEASE SPECIFY) � � �� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) �'^'�Q►I <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.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The END 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 /> 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$130 deposit prior to review. `BOXED AREA-EHD USE ONLY' <br /> ❑ Records provided by Staff-PPR Complete.Staff Name: <br /> EHD 4M6 06101/14 <br />