Laserfiche WebLink
PAGE 02102 <br /> 07/25/2007 14:29 510,434-";76 P51 INC *� <br /> EHO LOG NUMBER <br /> [}AT ;i�7) SAN JOAQUIN COUNTY <br /> "j) <br /> ENVIRONMENTALHEALTH,AEPARTME <br /> ;CO 304 East Weber Avenue, 3rd Floor;_Stockton,C:A.9S202- 8 <br /> �elephone: (209)468-3420 Fax: (209)464-0138 Web:www.Sjgov, <br /> , r..;.! ' : �ii;�r5 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i5 �.de a� 1� BUSINESSIAGENCY: t <br /> ADDRESS: <br /> PHONE(1):f7(�3 43Li `UO CXt 13 `PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: z", 71ma: <br /> (Pleate allow ttl business days from da of application submittal-'Tentative only-must be confined) <br /> 16 CHECK BOX TO EXPEDITE REQUEST-$93.00 FE (CASH�OR CHECK ONLY)-REgUEST PROCESSED IN Z BUSINESS DAYS <br /> SIGNATURE OF APPLICANT xi'. 'tet~��': „_ DATE <br /> UNIT DISTRIBUTION M Unit T ❑ Unit 2 0 Unit 3" CJ Unit 4 ❑Unit 5 ❑ Unit 6 A Other(eiectron101stslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> 4 Street f Street Name city <br /> 1. �1L ron <br /> 2. <br /> 3. -i-DO N a <br /> 4. LI aS� tL <br /> 5. y K. . ✓✓✓ <br /> 6. s - :�; <br /> 9 <br /> 10_ rw <br /> Specific Date Range of Information Requested:From -,. to -.. _. <br /> I ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I"NDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑Soup WASTE FACILITYNEHICLE <br /> d OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILrrY ❑WASTE TIRE <br /> 3 - ;^tf NDERGRQUNO TANK(MONiTORINGIREMOVAL) "❑D00 KENNEL ❑DAIRY - <br /> 1HAZARDOUS WA$TE GENERATOR A CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT - <br /> ❑TIERED PFRMnTED FACILITY ❑MoT@LIHOTEL PUMPER TRUCKIYARDICHEm Toa-Ers <br /> ❑TATT40I5ODY PIERCING ❑ppOLISPA ❑LAND USE"APPUCATiON SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAJLAOLE FOR REVIEW- MONDAY-FRjuAY$;00 AM-5,00PM - EXC DING Hot_IDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(S)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 20 4-0138 or mail to the aodE2ss <br /> kidicated above_ Address ranges will not he accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately tan(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> I A file that Is actively being"w'orked on by EHD staff may not be immediately available.for review. A new <br /> application may be stibmitted when the file Is available- <br /> 4, Any file not returned In the same condition as released will be reorganized by FHD staff at the expense of the <br /> applicant. .Futtire file reviews by the same applicant may require a$93,00 deposit prior to review. <br /> END 4e-02.60x _ - <br /> 414/NS <br /> �s <br />