Laserfiche WebLink
Sep 01 05 OG:23p Humphrey '26-3408 <br />DATE REC <br />oECS7,0 <br />MA, I <br />UNRONIV,EN f HEALTH <br />PHONE (1): <br />(��' 1 -1 <br />p - I", <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT #226g, <br />04 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br />Tele bone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />PHONE (2): <br />BUSIN ESSIAGENCY: <br />FACSIMLE: <br />TENTATIVE'' HT DATE: Thm: <br />(Please allow 0 business days from date of appikadon submittal-'TenhfB only -must be confirmed) <br />❑ CHECK BOX TO "s.00 FEE ASH OR HECK ONLY) - REQUEST PROCESSED 1113 BUSWESS DAYS <br />SIGNATURE OF APPLIC 1��� / DATE 3 /5 G <br />UMT DISTMOUT10N 1 0 Unit 1 M Unit 2 0 Unit 3 C] Ung Q Unit 5 0 Unit 6 C] Other (ekldrnTtkAefxAnaps) 1 <br />Stroat # <br />K:, -ITT -3:_ <br />Specific Date Range of Wbrr lation Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES MAR 2 7 <br />2006 <br />AS UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />O Housm AaATEmEHT <br />I 15 ]SD WASTE FAQP m/VEHK:Lf_ <br />' <br />d OTHER CLEAIIUP SITE (NoN-LOP)i- <br />E3FOOO FACILITY <br />A WASTE TatE - <br />*k UNDERGKCKMD TANK (MOrBTORIIV¢lREMOYAL) <br />HALUiDWs WASTEGENERATOR <br />G DOCS KENNEL <br />❑ CHICKEN RANCH <br />n <br />❑ DAIRY (� ( j ? j1, I i I <br />O WASTEWATER TREAT]Ml fiTO4Y1 <br />D <br />❑ TIERED PERMTT'TED FACKM <br />❑ MOTEL/HOTEL <br />C7 Pu*PEK TRvcKPYARO � <br />J <br />O TATTOOIBOGY PIERCING <br />0 POOLISPA <br />ei� APPLIGATKNI 9 <br />/ �S <br />❑ MEDICAL WASTE FAct rrY <br />25 OTHER (PLEASE SPEOM <br />•� . / ,11��"' <br />I <br />WELL AND SEPTIC PERI r RE -C ORDS ARE AVAILABLE FOR REYIEVI - MONDAYfRNAY W00 AM-5:00PM - eccLUDMIO HOLIDAYti <br />1. List up to ten addresses in the space above. Select the types) of files from the fist above by checking the <br />appropriate box(es). At "stone file type MUST be selected. €ax to (209) 0"138 or m;a to the MIc "s <br />indicated above. Address ranges will not be accepted —for additional assistamce with fits addresscs, contact <br />the EHD. Applications received after 3:0o pm will be processed the next business day. <br />2. The EHD wilt notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately ten (10) d�ys atter receipt of application. The files will be held for a maximum of fhre business <br />days for review. Appolnitmer>ts 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 sub pitted when the file is available. <br />4. Any file not returned in le <br />same condition as reased will be reorganized by EHD staff at the expense of the <br />applicant_ Future file v sews by the same applicant may require a $93.00 deposit prior to review. <br />1 <br />00 MM4" <br />1114MS <br />