Laserfiche WebLink
,, ENED ``"' SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 24 Nil � o <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> TelApRgiW: (209)468-3420 Pax: (209)464-0138 Web: www.sjgov.arg/ehd u <br /> ,EFm1T1SE? 1CF-S PUBLIC RECORDS RELEASE APPLICATION <br /> �1 II I <br /> APPLICANT: BUSINESS/AGENCY: G„cic�O+ti _— <br /> ADDRESS: 3,'i_34 CITY/STATE/ZIP: CA 95e.,2-1 <br /> PHONE (11: 2/� q',o- PHONE(2): FACSIMILE: I/6 'ySC7.C76C?3 <br /> TENTATIVE"APPOINTMENT DATE: It Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQ EST-$1 2 FEE(CASH OR CHECK ONLY),REQUEST PROCESSED IN 3 susiNESS DAYS \ <br /> SIGNATURE OF APPLICANT DATE 1j.,,4,/-I I <br /> Electronic Information: 0 List Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit 1 <br /> 1. 3550 6i-;W . oy, <br /> 2- ?��$(� q� Unit 2 <br /> 4. nk3 <br /> 5. �l <br /> Unit 4 <br /> 7. <br /> 8. <br /> ❑unit s <br /> 10. <br /> Q unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ©TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFIC) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY-FRIDAY 8:00 AM-5:OOPM(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 I2 i38 or mall to the address Indicated v . 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 confirmad 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 40-06 071P9M0 <br /> 100/1000 XV3 Z1 '. 11 11OZ/bZ/01 <br />