Laserfiche WebLink
SAN JOAQUIN LOUNTY E{ <br /> — EN ONMENTAL HEALTH DEPART z^.'�'� <br /> doeEast Main St. Stockton, CA 9520 r. <br /> _Thone: (209) 468-3420 fax: (209) 464=4138 We •SjgoV-org1ehd <br /> cd,pPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1\ •7T( b BUSINESSIAGENCY: �C-- <br /> : TEIZIP: <br /> ADDRESS: Z� J crrsrA <br /> HQACCSIMaISLE: <br /> PHONE(1): ONE(2) S ~ <br /> TENTATIVE'APPOINTMENT DATE: rI�a 2 Z b (7 Time: o <br /> {Please allow 10 business days from date of app ca ion sub I- TerttafivB only-must be conTirmed) T <br /> HECK BOX TO EXPEDITE REQ T-$115 SH <br /> CHECK.ONLY)-REQUEST PROCESSED IN 3 BUST ESS D:YS <br /> SIGNATURE OF APPLICA DATE <br /> Electronic Information: MLiStaMaP-9S__Crri_Pti0n:_A0 <br /> FILE ADDRESS EHD USE flNt <br /> :S <br /> Street# Street Name }} City ❑Unit 1 <br /> 2. r-�- �� �� t ";"iv .. Unit <br /> 4 � CJL� <br /> Unit 3 <br /> 5 3 -3 1� h S� <br /> IIS <br /> 6. <br /> z2:5 GL �vr X l Unita <br /> 8. 102:4 Fero C\+C, � � ��� � ❑Unit 5 <br /> 10. - Unit 6 <br /> Specific Data Range of Information Requested: From ( r C- to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT` SO LII?WASTE FACILITYIVEHICLE <br /> 93'OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> S?UNDERGROUNDTANK(MONITORINGIREMOVAL) ❑DDG KENNEL ❑DAIRY <br /> MIAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> l' {FRED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMiCAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES' <br /> ❑ MEDICAL WASTE FACILITY ❑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 tygd(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 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 field for a maximum of five business days for review. Appointments <br /> 14 should bescheduled accordingly. <br /> 3. 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 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$115 deposit prior to.review. <br /> 5. If,you need further assistance,please contact Diane Martinez;at(209)468-3425. <br /> EHE)USE ONLY. <br /> i <br /> EHD 46.0 <br /> E1;V09 <br />