Laserfiche WebLink
*ECEIVED S066 'ON Wd9nl 8L06 9G 'ups aulll pan aDa� <br /> • tQ A NvJ O A Q U I N �A� � 620111.3Environmental Health Department <br /> COUNTY-- PCI PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness grows herFWRQNMEWALMCA`t.Ttt <br /> PERWITMEff ItE9 EHD LOG NUMBER; 97193q <br /> APPLICANT: BUSINES AGENCY: ,65 V, .7-kv FY (Pf C, <br /> ADDRESS: a � L CITY/8TATE2IP: o S �o Z <br /> PHONE(1): TO PHONE(2): 0,? FAX OR E-MAIL: ' <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE <br /> 1. Llai un to ten addresses In the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138, mail to the <br /> addrespin4lr.otgglbRI52W. or-ejnalitoinfogAlgqhd.com. Applications received after 3:00 pm will.be processed the next <br /> business day. <br /> 2. For assistance In Identlfying the nature and content of END records,please contact EHD at the number noted below. <br /> 3. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately tan(10) <br /> days after recelpt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑Map-Description: <br /> Specific Date Range of Information Requested: From 20 oo to O/ <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> [R Undervreund Tank(UST) Street 0 Street Name city <br /> Cleanup t3tte(LOP) c'4evbkee ZA-e ��,. gsrt i��t,i� <br /> g ry ❑CONSUMER <br /> �thor Cleanup Site(Non-LOP) !y�' c - <br /> [g-1-lazardoua Waste I-]DARY <br /> ❑Tlared Permitted Fmjltty 2 <br /> [&'Abovoground Tank <br /> UST (Monitoring/Removal) 13 PWS <br /> Hazardous Materials <br /> F]Spill/Release Response <br /> Salk Waste Facility/Vohido 4 eTEn QuMAY <br /> D Food Facility <br /> ❑Pool/Spa ml Mrtrcaenpw ' <br /> Dalry 5 <br /> Land Use Appliredon Shea <br /> ❑ <br /> Septic Pumper Truck Hous]Na6 <br /> Yard/Chemical Toilets *k, 1-31--I <br /> El Wastewater Treatment Plant ® UPA <br /> �HouslagAbatomont 7 AUT/HM/HW <br /> Mctel/Hotel <br /> ❑Chicken Ranch/Dog Kennel UPA <br /> e <br /> rj Medical Waste Facility UST <br /> []Tattoo/Body Piercing <br /> ❑ <br /> 71 Wosto Tlro 9Sous w. <br /> 71 Complaint <br /> ❑Other(Please Specify), ❑AccavmNo <br /> +o <br /> —BOXED AREA-EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR Complete. staff Name- EHV A"e <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com :■ <br /> ■i <br /> T�T;a6pd 82Teb9b602T:01 329G2eb80t7T+ =1:w0-JA 2S:ST ST02-2-T-NU,.11111, <br />