Laserfiche WebLink
j <br /> Oct 01 08 02:10p Geologica 41 a7-7880 p.1 <br /> p,�7� SAN JO7 �AQLIIN COUNTY EHD LOG NUMBER <br /> -s �� <br /> �� <br /> D) ENVIRONMENTAL HEALTH DEPARTMENT <br /> UG ( ��� 600 East Main Str6et, Stockton, CA 95202-3029 1 <br /> �elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd <br /> �' �;M1i HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> %S� l / <br /> APPLICANT: P44 G�4CJ <br /> n S BUSINESSIAGENCY: G��` d <br /> r ADDRESS: L p er J rPre Citylstatefzip [.t retq [ lay yp�6 <br /> PHONE(1): LIr �' `j f_ -� t) ZPHONE(2): FACSIMILE: Y✓� �4 '�{/p U <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> {Please allose 10 business clays from date of application submittal-'Tentative only-must be confirmed) <br /> Opt CHECK BOX TO EXPEDITE REQUEST $1 F ASH OR CHECWNLY)-REQUEST PROCESSED IN 3 BU I71� <br /> S OAYS <br /> SIGNATURE OF APPLICANT DATE l} <br /> Electronic Information: ❑ List n Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> S(reet$ Street Mame City <br /> 1 � ! ❑ Unit t <br /> ! <br /> 2. Un1t2 <br /> 3. (' J� Cjr.w� <br /> A- Unit 3 <br /> 5 rYr� <br /> 6. 5 Unit4" <br /> 7. r <br /> ❑ Units <br /> 8. V <br /> g' Unit6 <br /> 10. <br /> Specific Date Range of Information Requested:From . to lP$Prt <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ' -- UNDERGROVND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A8AT>;%1FNT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUPSn-E(PION-LDP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MOMMORNWREMOYAL) ❑ DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR CI CHICKEN RANCN ❑WASTEWATER TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY Q MOTEL/HOTEL ❑PUMPER TRUCKIYARO(CHEM TOILETS <br /> ATTOoIBODY PIERCING Q POOLISPA /nLAND SEA PLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPEcl" 99 ❑A— j&14- S P"- tL <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAELEFOR REVIEW- MONDAY-FRLoAY8:00 AM-5:00PM - EKcLilome HOLIDAY$. <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 prn 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 avallable. <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$105 deposit prior to review. <br /> .EHD-USE-ONLY -- --- <br /> 4 <br /> I <br /> EHD 48.06 8fD4108 PUBLIC RECORDS RELEASE APP FORM <br />