Laserfiche WebLink
From: 07/22 13 14:18 #429 P.002/002 <br /> EHD LOG NUMBER <br /> LJSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUL N 201:1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> r'E7,1 )1Ff ` w fi'!i>> .'> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 55 \IAXD BUSINESS/AGENCY: <br /> ADDRESS: �- M Cr-CITYISTATE/ZIP: I rl<a-J <br /> PHONE (1) ?-0E-FPHONE (2):Cc O. .o�0FJZld'/,fT3*ACSIMILE: <br /> T NT TIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of applicatio submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 25 FEE(CA R ECK ON -REQUEST PROCESSED IN 3 BUST SS DAYS <br /> SIGN�A-T-URE-OF-AP-RLICANT - - — --� - DARE <br /> Electronic Information: ❑ List❑ Map-Descriptioti: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> J_ I—)Unit 1 <br /> 2• �� '� ❑Unit 2 <br /> 3. <br /> 4. - 1S 1 77/6 IeUnit3 f . <br /> 6• 2 Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> Q units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL H ACTH DEPARTMENT FILES <br /> �j 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(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> FSR I HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑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 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 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$125 deposit prior to review. ^" OY Af3El+. ijS 3 .jJLY <br /> >7 Records prtw �eff=PPR_Complete Staff:Name r <br /> EHD 48-06 914112 <br /> Received Time Jul. 22. 2013 2:20PM No. 3653 <br />