Laserfiche WebLink
DATE RECEIVED EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> = Moog Telephone, (209) 468-3420 pax: (209) 464-0138 Web: www.sjgov.org/4d44! <br /> C'H' PUBLIC RECORDS RELEASE APPLICATION <br /> ��,f�1?FtIC41V : / Sail (�►r� h(t� 70� BUSINESSIAGENCY: <br /> ADDRESS: 1-:2(/ IJr 'Cr /f Ids /V CltyfState/Zlp �PV-7 � ;_ ��7 <br /> PHONE(1): C�4� `,�J (SSG) PHONE(2): '�O -_� � FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE:1 V1 bv� J C'�hs '�-00 17 Time: l- Q 6 ED-) <br /> (Please allow 10 business days from date of application submittal 'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDI7w7mz= <br /> ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �j --0�3 — <br /> Electronic Information: ❑List ❑ Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> ,. leas H61 <br /> 2. <br /> [] Unit 2 <br /> 3. <br /> 4. unit 3 <br /> 5. <br /> (3 Unit 4 <br /> 7. <br /> f3 ❑ Unit 5 <br /> 9. <br /> 10. ❑ unit 6 <br /> Specific Date Range of Information Requested:From [� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �DCRGROUNO TANK(UST)CLEANUP SITE(LAP) O HOUSING ABATEMENT CG SOLID WASTE FA.CILITY/VEHICLE <br /> THER CLEANUP SITE(NON-LOP) 71 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONFrORIN(;IREMOVAL) C DOG KENNEL O DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY CI MOTELIHOTEL Q PUMPERTRUCKIYARD/CHEM TOILETS <br /> G7 TATTOOIBODY PIERCING ❑RCtLISPA12 LAND USE APPLICATION SIT <br /> �^ <br /> ❑MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)�S CG i�[I YICPGI I')'" o T'r ok91- (OC�1u/Ll <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FoR REVIEW - MONDAY--FRIDAY 8:00 AM-5. - 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(700)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 /> Z 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 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 /> r <br /> i <br /> EHD 48-06 8/C4I08 PUBLIC RECORDS RELEASE APP FORM <br />