Laserfiche WebLink
DATE RECEIVE EHD LOG NUMBER <br />�h SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 4640138 Web: www.sigov.org/ehd TP <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Mairc BUSINESS/AGENCY:Zk4 Gui y►edCA' Al s-ck <br />ADDRESS: UZ I 4. l&MC5 CITYISTATEIZIP: U)% 4? 5 ZGl <br />PHONE (1): " P7,�,'2,,1-K PHONE (2): FACSIMILE: f 1026-- X1532. <br />TENTA7! E*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 ST - $125 F E (C R CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE i `2. / % 13 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY -street <br /># <br />Street Name <br />City <br />5� <br />(h <br />UOML <br />4. <br />6.6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />29 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY [:]SOLID WASTE FACILITYIVEHICL <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE "' 61P-5, ,"( /t ' <br />UNDERGROUND TANK (MONITORINGIREMOVAL,)A[]FOOD FACILITY ❑ DAIRY 17- 77-/3 <br />ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />} HAZARDOUS WASTEIHAZARDOUS MATERIALS. ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />] TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />] TATTOO/BODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ 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 tan 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 (20 9) 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 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 new 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 ex ense of the applicant <br />Future file reviews by the same applicant may require a $125 deposit prior to review. n E G <br />0 CQ UV ' >' (i, U 5 <br />