Laserfiche WebLink
0 10/10/2013 2:271)N FAX 20001/0001 <br /> le EHD LOG NUMBER <br /> ENE® SAN JOAQUIN COUNTY �0 <br /> OCT 10 Z013 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov,org/ehd <br /> ENVIRONMENTALHEALTH fr--7, <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION Iw jl <br /> SH <br /> APPLICANT; _ M �� 7 BUSINESSIAGENCY:� <br /> ADDRESS: �((11 `L \7(Q (//I A� , ��1 A� CITYISTATE/ZIP: C c( �A� <br /> PHONE(1): - 77 Z lIJV PHONE (2); t}rl (p7a FACSIMILE,7_N ' [ q- ql� 0` <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-•Tentative only-must be confirmad) <br /> �(CHFCK SOX TO EXPEDITE REQUEPTli FEE(C CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATES <br /> Electronic information: ❑ Lis Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City QUnit t <br /> 1. L , 1- Lc <br /> 2. 7 - ❑Unite <br /> 3. <br /> 4. u Its j <br /> 8. <br /> Id Unit4 <br /> 8. ❑units <br /> 9. <br /> 10. <br /> El Unit 8 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) I❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY rr❑yy POOUSPA El LAND USE APPLICATION SITES <br /> F]TATTOOIBODY PIERCING IU COMPLAINTIRESPONSE RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABCLE FOR REVIEW: MONDAY-FRIDAY 5:00 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(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 application may be <br /> submitted when the file Is available. <br /> 4. Any flle not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file revlows by the same applicant may require a$126 deposit prior to review. —BOXED AREA-EHD USE ONLY^ <br /> ❑:Records provided ib'ysStaff`PP12 Complet :'smtl Namei.' <br /> EMD d8.06 9102 <br /> Received Tlme Oct. 10. 2013 2:26PM No. 4281 <br />