Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENV IRONNIENTAL HEALTH DEPART1vIENT <br />C <br />�❑ 600 East Main St. Stockton, CA 95202-2705 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: «vwNv.sjgov.org/ehd <br />APPLICANT: <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY: 1-1-017 D� C <br />ADDRESS: /PO B4Ox lC V CITY/STATE/ZIP SQ Q e!!�&, <br />PHONE (1): (glty�a�%5 ���� PHONE (2): FACSIMILE: ��— <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />El CHECK BOX TO EXPEDITE REQUEST - $115.00 FEE (CASH OR CHECK ONLY)-1REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �e 7oho/2�/0��- /�, TIS �CIDATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />2 <br />❑ SOLID WASTE FACILITY/VEHICLE <br />FILE ADDRESS <br />Street Name <br />City <br />EHD USE ONLY <br />❑ Unit 1 <br />Street # <br />❑ DOG KENNEL <br />7) DAIRY <br />HAZARDOUS WASTE GENERATOR <br />E) CHICKEN RANCH <br />❑ Unit 2 <br />3. <br />11 MOTEL/HOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ Unit 3 <br />4. <br />5. <br />6. <br />11 LAND USE APPLICATION SITES <br />El MEDICAL WASTE FACILITY <br />El OTHER (PLEASE SPECIFY) <br />❑ Unit 4 <br />7. <br />8. <br />9. <br />❑ Unit 5 <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />0 HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY/VEHICLE <br />I] OTHER CLEANUP SITE (NON -LOP) <br />i] FOOD FACILITY <br />ID WASTE TIRE <br />71 UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ DOG KENNEL <br />7) DAIRY <br />HAZARDOUS WASTE GENERATOR <br />E) CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />�O TIERED PERMITTED FACILITY <br />11 MOTEL/HOTEL <br />❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />0 TATTOO/BODY PIERCING <br />11 POOL/SPA <br />11 LAND USE APPLICATION SITES <br />El MEDICAL WASTE FACILITY <br />El OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:OOPM - 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 (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. 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 EHD staff may not be immediately available for review. A new pplication 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 xpe e a I ant. <br />Future file reviews by the same applicant may require a $115.00 deposit prior to review. y,l <br />EHD USE ONLY <br />***If you need further assistance <br />please contact Diane Martinez (209)468-3425 <br />directly. <br />Th You*** <br />-ed <br />nep) <br />/gem <br />EHD 48-06 8/01/2009 <br />