Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVI NMENTAL HEALTH DEPARTM NT <br /> 600 East Main Street, Stockton, CA 95202 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> pp :PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 4—U Iz. — BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE(1PHONE(2): d S C^—ZC+O b FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal=*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU $95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE V9- Z.Z- a'? <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit I <br /> I. 20 <br /> 2.- ❑ Unit2. <br /> 3. <br /> 4. ❑ Unit 3 <br /> sJ, i <br /> 6. <br /> Unit 4 <br /> � <br /> 7. <br /> ❑ Unit 5 <br /> 8. ._.... . 1. - <br /> 9. <br /> � ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP). Cl HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) it FOOD FACILITY d WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) El DOG KENNEL ❑`DAIRY - <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH C]WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> CI TATTOOIBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 11 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR.REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM -'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. Faxto-1209)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 review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be hold 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.now 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. I <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you should need further assistance please contact Diane Martinez @ (209) 468-3425 directly. Thank You*** <br /> END 48.06 5/1672007 - { <br />