Laserfiche WebLink
rr <br /> Oct 03 05 11:26a Drew Van Allen �- . 209-667-9668 p.1 <br /> DA RECEIVtb'fkJII EHD LOG NUMBER <br /> C- <br /> , ,-- I; ,\- j' SAN JOAQUTN COUNTY <br /> u EMrIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: K-vw.sjgov.orglehd <br /> `��` •t "t�' '� '"' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��'( Q ^ Ai4� BUstNESSIAGENCY: <br /> ADDRESS: Z-j::Z1 �w �- �*.� Til ori'+ , <br /> PHONE(1): 7- C4� -U��?- PHONE(21: i F retia` - �o $ `t FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE: �� (� o� Time: 0� 3Q <br /> (Please allow 10 business days from date of application Submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$13-00 FEE(CASH OR CHECK ONLY)-RECUEST PROCESSED IN 3 BU17[NESS DAYS <br /> SIGNATURE OF APPLICANT '`-��+,-- DATEdal xI�o l"" <br /> uHrr DIsTRiBUT1oH ❑ Unit 1 E3 Unit 2 tl UnUnita Unit 5 C3 Unit 6 E3 Lather(electroniclllstsimaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street if Street Name City <br /> t. �ZE71 1Q o M4 4 - i Fm.KN, CG <br /> 2. t`t�f 1 dor.-46 S*r tea.#- �IC�-+ <br /> 3. Z oS it c ra+'b t-f�+- 5 1c,$•o-� " <br /> 4. F- X41 C114 r� t,to S uS <br /> 5. { SI 0 C%V.•)a s4-. Ir- :2 j D (p <br /> 6. Lam(aZ a t,- <br /> -IRS zzld <br /> 7. X33 C1,.pta„r v�lQ �Lti1a-. <br /> 8• 37,3CA N ta4- Lexi S i <br /> 9. 2c1�S ou flr•I�rt. s#-Qc.+c -� <br /> a- Q— pv re.- 3 LIG -• <br /> Specific Date Range of Information Requested:From Zz�03 to (`},r^-%A- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ^ <br /> r41 411DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HousING ABATEMENT e3 souo WASTE FACILn dVEHICLE <br /> E3 OTHER CLFANUP SrrE INON4-OP) 13 Foot)FACILITY ❑WASTE TIRE <br /> C3 UNDERGROUND TANK(MOPS TORINGIRemovAL) O DOG KENNEL C3 AAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ., O CRCKEN RANCH O WASTEWATER TREATMENT PLANT <br /> ❑TIEpxx PERMirn.D FACILM 0 MOTELIHOTEL O PUMPER TRUCKIYAROfCHEm TDILETS <br /> 13 TATTOOIBooY PIERCwG ❑ P OOUSPA in LAM Use APPLICATION$ITE$ <br /> 13 MEDICAL WASTE FACILITY t1 OTHER(PLEASE SPECIFY) <br /> WELL AND SrprC PERMIT RECORDS ARE AVAILABLE FOR REmEw - MONDAY"FRIDAY 5:00 As1-:00PIe - EXCLuDm HOLIDAYS. <br /> I. List up to ten addresses in the space above. Select the type(s)of fifes from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses, contact <br /> the EHD.Applications received after 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 review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of,five business <br /> days for review. Appointments 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 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 4""06 <br /> znaras <br />