COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

� PM No. 0139 EFIP• 1;NUMBER ■ D RECEIVED" SAN JOAQUIN COUNTY ■ ENVIRONMENTAL HEALTH DEPARTMENT �■ APR 0 q 2015 1 ■ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ■ J hone: 209 4G8-3420 Falxo 209 464-0138 Web: www.s ov.or /end fi�Nvlt�Olvin��al;- �� ( ) ( > ig g s\l ?ERIMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: & Sr L/- �. BUSINESS/AGENCY: APPLICANT: & �J �-'°� ✓1✓u�1 P`2 L' 'I'l ADDRESS: US--33 B CITYISTATEIZIP: PHONE (1): SI6-�2-IA'7— 188T__009_PHONE (2): FACSIMILE: Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑ CHECK BOX TO EXFEDII'E REQUEST-$13 E ASITOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: ❑ List❑ Map— Description: FILE ADDRESS EHD USE ONLY Street# Street Name City ❑Unit 1 2. �f T ❑ Unit 2 3. W U�0 4. F1 Unit 3 5. ❑Unit 4 7. 8. ❑ Unit 5 9. J 10. ❑'Unit 6 Specific Date Ranee of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL IIASTEVVATERTREATMENT PLANT ,HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES ❑TATTOWBODY PIERCING �CCMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) WELL,AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5.,00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not he accepted.Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact FHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future fife reviews by the same applicant may require a$130 deposit prior to review. *",BOXED AREA-EHD USE QNLY' ® Records provided by Staff-PPR Complete. Staff Name: Received Time=Apr, 9.:=2015= 3: 17PM=No. 8496 a8,01114 env uo-vo