Laserfiche WebLink
tYIU LUIi IVUMtitK <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> n[EC IC 2��n E D ENVIRONMENTAL HEALTH DEPARTMENT <br /> Lf�l v 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> MM Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 3 <br /> q 7005 <br /> FNVIR-Ah- fNT HFAI TH PUBLIC RECORDS RELEASE APPLICATION <br /> APPM 06 P l BUSINESS/AGENCY:A'n&14 <br /> ADDRESS t <br /> PHONE(1): Al2 - 64&7-�b�, Q;� PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) 4 <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS ry <br /> SIGNATURE OF APPLICANT it DATE �l <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> O <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. <br /> 3. <br /> 4. <br /> 5. J <br /> 6. 3 <br /> 7. <br /> 8. <br /> 9. <br /> 10. _ <br /> Specific Date Range of Information Requested: From Ad �,.� 92 to molt�-u �T .y0 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOUSING ABATEMENT I]SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY 1:1 WASTE TIRE <br /> 13 UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL CI DAIRY <br /> HAZARDOUS WASTE GENERATOR El CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT t <br /> TIERED PERMITTED FACILITY El MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS V- V <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA SE ON SITS ./ <br /> Al <br /> O MEDICAL WASTE FACILITY 13 OTHER(PLEASE SP IF {J <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> type(s) I <br /> 1. List up to ten addresses in the space above. Select the e s of Iles from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact (� r <br /> the EHD. Applications received after 3:00 pm will be processed the next business day. 2,1 <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed ) - <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business ti <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 4"2-006 <br /> 11!23104 <br />