Laserfiche WebLink
4 <br /> D ec, SAN J OAQU I N COUNTY EHD LOG NUMBER <br /> ZD14 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue Stockton CA 95205-6232 <br /> LTi,, ICES (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov'.org/ehd <br /> NV1RaNM <br /> �tth1�IS�R PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: T �y��-1 BUSINESS/AGENCY:_ <br /> ADDRESS: CITYISTATE/ZIP: C <br /> PHONE(1)-'22Q --->— PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMEIV DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESS -!N-3•BUSINESS DAYS <br /> SIGNATURE OF APPLI(yA'NT ,��� ---� ,DDAATE <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City [Unit 1 <br /> 2. <br /> d unit z <br /> 3. <br /> 4. I�Unit3 <br /> 6. Unit 4 <br /> 7. <br /> 9. <br /> 10. LO] Unit G <br /> Specific Date Range of Information F.equested: From 5./a to Z. L 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br /> [ ]OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING1REMovAL) Ej]FOOD FACILITY DAIRY <br /> ]ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL ❑WASTEWATERTR2=ATMENT PLANT <br /> ❑} HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> [j]TIERED PERMITTED FACILITY POOLISPA ❑LAND USE APPLICATION SITES <br /> [F]TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 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 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for reviewwill 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 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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD as-as 914112 <br />