Laserfiche WebLink
JUN-4-2099 10:23A FROM:GEOPHA�` EMU 2095693295 `- .4640138 <br /> P.2 <br /> DATE;RECEIVEO <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> tl ��4elephone: <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton CA 95202-3029 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.sjgov:org/ehd <br /> ,1i1N 0 4 2009 3731 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ENO ,T Hkgt& o r BUSINESSIAGENCY ��..✓ <br /> Cfty)StatelZip4 <br /> / <br /> PHONE(1): ��_ 4O'Z�j PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: _ Time: <br /> (Pieass 8I10w 10 business days from data of appilcation submltUl-•Terltadv*anly-must be conflrmed) <br /> CHECK BOX TO EXPEDITE REQUEST`-$106 FEE(CA H OR CHECK ONLY)-.R QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTdATI~ <br /> / <br /> _ <br /> Electronic Informatlon: ❑List❑Map—Description: <br /> r <br /> FILE ADDRESS EHD'USE ONLY <br /> Street# Street Name C"V <br /> Unit 1 <br /> F33. <br /> P � nit 2 <br /> I'7 ';E- '41V'0r 4;1 <br /> . <br /> 6. <br /> 7. <br /> _..-- ❑ Unit 8 <br /> 8. <br /> _ ❑ unit 6 <br /> L19o. — <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT"FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT f3 SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) Q FOOD FACILITY ❑WASTE TIRE <br /> ,AyNDERGROUNDTANKIMONITOMNWREMOVAL) ❑DoGKeNNEI ❑J)A1RY <br /> A7ARDOU5 WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLISITES <br /> ❑MEDICAL WASTE FACILITY OTHER(PLEASESPECIFY) 0'kW 716 . 739 mo <br /> T <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRID Y 8:00 AM-6.00PM - 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 209 484-0138 or mail to the ddress In iceted above. Address <br /> ranges will not be accepted—for additlonal assistance with file addresses,contact the EMO..Applications received after <br /> 3:04 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 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 now application may be <br /> submitted when the file is available. <br /> 4. Any File not returned in the same condition as released will he reorganized by EHD staff of the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4"S 8104100 PUBLIC RECORDS RELEASE APP FORM <br />