Laserfiche WebLink
DATE RECEJJJVED EHD LOG NUMBER <br /> SAN .10AG1UIN COUNTY <br /> _NVIRONMENTAL HEALTH DEPARTMENT <br /> // 1868 East Hazelton Avenue, CA 95205-6232 <br /> � Stockton, <br /> Telephone: (209) 468-342.0 Fax: (209)464-0138 Web:wvm,.sigov.org/ehd <br /> I ?UBLIC RECORDS RELEASE APPLICATIOy <br /> APPLICANT: F t tvul+asoJ1 BUSINESS/AGENCY:- enu <br /> ADDRESS: ,ro Dy, �L,. e W CITY/STATE/ZIP: "j' ie�` t! Lr 'f} <br /> PHONE('1):PpQ ej+�(�� ?t`,1 PHONE(2):Wq-2Q$P 8g .� FACSIMILE: <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 /> ❑CHECK BOX TO EXPEDITE REQUEST-$130 FEE( H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . �✓ DATE I1'2•5/ I / <br /> Electronic Information: ❑ List❑ Map-Description: f <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City ©Unit 1 <br /> 1. 93-2 honks e- t on _ (� . <br /> 3$ a -e a I <br /> 2. `Q t e - ��'�Ilty El 2 <br /> 3. Ll <br /> 4. 1� 1Idunit 3 <br /> a. <br /> s. • 9�y tau�t4 <br /> 7. <br /> Ih <br /> 8. Q Unit 5 <br /> 9. <br /> 0. <br /> ❑Unit o" <br /> Specifie Date Rarn,q.of information Requested: From (0 a to tr'J t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TAui((LIST)CLEANUP SITE(LOP) F I MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(Nou-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(P+ONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> `©ABOVEGROUND TANK ❑CHICKEN RANCI-II DOG KENNEL ❑WAS1hl'fATER TREATh9ENT PLANT <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUttPERTRUCt(IYARDICHEle.ICALTOILETS <br /> TIERED PERIJITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ARI-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files frorn the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0136 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 'rhe EHD will notify the applicant if any EHD files exist. An appointment for raview will b--confirmed 4pproximate1y ten(10) <br /> dFys after recolpt of Epplication. The files will be held for a m,ximum Of five business days for review, Appointments <br /> should bs scheduled accordingly. <br /> A,ny 'Re not i ;urn. d in khi!same conoitlon so r leased f all be reorganized Gy z.H0 staff at thS of th,acplic <br /> Fes L:e 411 b;Vie szmc appOcant may reyuii a$130 deposit prior to revicvl. ' `80.ED AREA-EHO USd <br /> 'i-1 Ccra.pl�4a. Zt&ii R'3rna: <br /> .o-D a-0 oe ovia <br />