Laserfiche WebLink
0 <br /> DATE RECEIVED — _>, EHD LOG NUMBER <br /> "" SAN JOAQUIN COUNTY <br /> L ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Tel,�phone: (209) 468-3420 Fax: (209)464-0138 Web: rg/ehd5 <br /> I,I . <br /> y I , - <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kyi4en th, %, BUSINESS/AGENCY: L <br /> dc <br /> ADDRESS: Jq!A tVte_ ,lsM Are S..,1. C CITY/STATE/ZIP: <br /> PHONE(1): tQ-O'jn*jfo PHONE(2): (S3o) ZZI-Y'(•to FACSIMILE: 6116) gfiy -o('03 <br /> TEN)rA /VE'APPOINTMENTDATE: Time: <br /> (Pleuse allow 10 business days from pato of apphration submittal-•Taetalive nnly-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUES -$122 EEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r DATE q'f;,.e <br /> Electronic Information: ❑List E3Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City El unit i <br /> 2, tatW.AkLAJ Unit 2 <br /> 3. t <br /> 4- <br /> S. R-S <br /> 6. 3q r ndi: <br /> 7. -- _ <br /> 8. <br /> S. ❑Unit 3 <br /> 10. <br /> ❑unit <br /> Specl lc Date Range of InformaUon Requested: From to BVW,41(. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> ®OTHER CLEANUP SITE(NON-LOP) [:3 Fool)FACILITY El SOLID WASTE FACILITVNEHICLE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL El WASTE TIRE <br /> [j DAIRY <br /> W HAZARDOUS WASTE GENERATOR <br /> ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANE <br /> ❑TIERED PERMITTED FACILITY ❑MOTEIIHOTEL <br /> ❑TATTo0B0DY PIERCING ❑PUMPER E APPLITRUCKICATION <br /> SITES TOILETS <br /> ❑POOIISPA E]LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ®OTHER(PLEASE SPECIFY) <br /> WELLAND 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(20914640138 or mall 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 behold for a maximum Of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 9. 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 flie 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$122 deposit prior to review. <br /> �He use Dery <br /> EHe sane at t ur <br /> 1 t'WZb OW ANVL rCw N1ci w(y, c Nt+tN 1•C'� J 1` r f.• arneHe <br /> Ac veay vto�a1 w4 t.•q, .hn..,rt;vy LOTS tAsn 4 ON v ,cal *A o� <br /> rr" t• , 1 Q i , 1 E.vl.�hrta lwaw f�.W,lat. <br /> 100n ooln XVj 19- L0 010d/E1/60 <br />