Laserfiche WebLink
0CT-1�-2013 08:32A FIRDII:GEOPHASE 2095690295 Tr - 4121138 P.2 <br /> EHD LOG NUMBER <br /> " IVED SAN JOAQUIN COUNTY P* <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1-Y I'll <br /> OCT 17.2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 41�W.401-e <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITfSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> Ael <br /> 'w _ <br /> LT C/ BUSINESSIAGENCY: (5�ea Aa SP <br /> APPLICANT: 7-,'r/e- /, Le CITY/STATE/ZIP: /7�p %IZL-1 <br /> ADDRESS: veli en-an A _7 <br /> PHONE (1): OXY PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: /6), Time: <br /> (please allow 10 business days from date oflapplication submittal-'Tentative only-must be confl,..d) <br /> ,QKCHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FElectronic Information: ❑ List 0 Map—Descriptioll' EHD USE ONLY <br /> FILE ADDRESS <br /> city Col Unit 11 <br /> Street# Street Name <br /> rin C <br /> Unit 2 <br /> 3. <br /> 4. <br /> —2-elit 3 <br /> 5. 47q 13_Unit 4 <br /> 6. <br /> 7. <br /> El Unit 5 <br /> 0 Unit 6 <br /> 110. 1 to <br /> Specific Date Range of Information Requested- From <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT Ej SOLID WASTEFACIUTYNEHICLE <br /> XyNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> OTHER <br /> TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY L]DAIRY <br /> UNDERGROUND RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑ABOVEGROUND TANK ❑ <br /> MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> _AZARDOUS WASTE/HAZARDOUS MATERIALS ❑ <br /> POOL/SPA <br /> ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑F-I COMPLAINVRESPONSE RECORDS F1 OTHER(PLEASE SPECIFY) <br /> ❑TATTOO/BODY PIERCING <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 11. 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. Appllcatlons received after <br /> 3:00 pm will be processed the next business day. r review will be confirmed approximately ten(10) <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment fo <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. t be immediately available for review. Anew application maybe <br /> 3. A file that is actively being worked on by EHD staff may no <br /> submitted when the flle is available. as released will be reorganized by EHD staff at the,qxpense of the applicant. <br /> 4. Any file not returned in the same condition `*'BOXEfj AREA SID U.SE ONLY <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> ed by Staff PPR Comotef.- <br /> 0 Records provided by:Staff-PPR p etei Sufft Name; <br /> 9/4112 <br /> EHO 0-08 <br /> n I T:--- 0_� 1� OA`I '� 11 - nOAKA Nn 0 4 <br />