Laserfiche WebLink
RECEIVED lJS <br /> DATE RECEIVED EHD LOG NUMBER <br /> APR 14 2016 SAN JOAQUIN COON <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEg,LT� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PFRMIT/SERVICEre1ephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: ULE e <br /> S<OCJ7 ?"S <br /> ADDRESS: <br /> CITY/STATE/ZIP: &ow'VS bllm -c�J FS-1/� <br /> PHONE (1): _� I S fin,(per PHONE(2): FAX OR E-MAIL: da le'L( ., -&,� <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(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONL-Y <br /> Street M Street Name City <br /> 1. 7 ' 4 Ud w(�sT' INI 1 Loi <br /> 2. ❑Unit, <br /> 3. M/U.it 2 <br /> 4. <br /> ❑Unit 2H <br /> 5. nit3 WOOD <br /> • 6 Unit 3HM 1 <br /> 7. <br /> j ❑Unit 4 <br /> B' SITE MITIGATION <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range of information Requested: From to <br /> S <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEL/HOTEL ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑FOOD FACILITY <br /> T3NNDERGROUND TANK(MONITORINGIREMOVAL) ❑WASTE TIRE ❑DAIRY,POOLISPA <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> AZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY '�NOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPNt(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(2091464-0138 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. 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 held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <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$130 deposit prior to review. <br /> ""BOXED AREA-EHD USE ONLY"* <br /> • <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br />