Laserfiche WebLink
02-27-'15 13:37 FROM- T-501 P001/001 F-788 <br /> UAIt'%C *" tnu Luts rvumbtK <br /> f SAN .JOAQUIN COUNTY <br /> lk <br /> !V /� <br /> 8ENVIRONMENTAL HEALTH DEPARTMENT <br /> ✓ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Z 9 4�ffphone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> �NV1IgpN <br /> pF MENT'it PUBLIC RECORDS RELEASE APPLICATION <br /> yeBUSINESS/AGENCY: OAR-A^ in)APPLICANT <br /> ADDRESS; CITYISTATE/ZIP: <br /> PHONE(1): F11-;;-\ ;(jam PHONE(2):�LI�'L�-o^`J3)L FACSIMILE: q��- �.GIn -(3�LL <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 REO T- 1 0 FEE(C H OR CHECK ONLY)•REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I <br /> Electronic Information: ❑ List[] Map-De ription: <br /> FILE ADDRESS EHD USE ONLY <br /> 9treat# Street Name City ❑Unit a <br /> 1 t b, k AL <br /> 2. Ig - ,A fvl 01Unit2 <br /> 3. ^; n <br /> 4 2 M=� <br /> y Y <br /> � �(� QJ _p U Unit 3 <br /> 5. <br /> 6. 3 S ❑Unit 4 <br /> 7. <br /> 8. El Unit 5 <br /> 9. <br /> 10. <br /> El Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> 0 ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 9 HAZARDOUS WASTEIHA2ARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARO/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND 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 riles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the address indicated above. Address <br /> ranges will not be accepted.Applications received after3:00 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 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 /> 4. Any File not returned in the same condition as released will be reorganized by EHD staff at the expanse 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 /> EMD 48-06 08101114 <br /> Received Time Feb. 27. 2015 1 :31PM No, 8231 <br />