Laserfiche WebLink
1.2/30/2005 08:11 FAX 510 420 P;aD CAMBRIA 16001 <br /> U., c nca1C1VrU EHD LOG NUMBER <br /> ;� SAN JOAQUIN COUNTY <br /> U E !� ENwRONmNTAL HFALTH DEPARTMENT <br /> 304 <br /> East Weber Avenue,3 Floor, Stockton,CA 95202-2708 <br /> Ur a LOSS Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgoy.org/chd91 <br /> NEALi H PUBLIC RECORDS RELEASE APPLICATION <br /> APtI BUSINESS/AGENCY: <br /> ADDRESS: $�e7d oG+as jj,�* j-- .Sc►/7 .� ,c,IETNysa �'.� y r7�4 0$ <br /> PHONE(1): 5-1n PHONE(2): — <br /> FACSfMfLE:�'7o <br /> TENTATIVE*APPOINTMENT DATE: ,fA,t /.3�Zoo!o Time•m9bo <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ® CHECK BOX TO ExPEDITE RE UEST-$83. 0 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT --- DATE em sold 2,Q 5 <br /> UNIT DISTRIBUTION ❑Unit 1 ❑ Unit 2 ❑Unit 3 ❑Unit 4 ❑Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS <br /> street# Street Name EHD USE ONLY <br /> I <br /> . ee o <br /> 23 t s7 <br /> S !W, <br /> ,. <br /> Specific Date Range of Information Requested:From .amu. ,fct _ to <br /> 090THER <br /> ENVIRONMENTAL HEALTH DEPARTMIIENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT E3SOLID WASTE FACILRY/VEHICLE CLEANUP SITE(NON-LOP) I❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL. ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFI7 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 0:00 AM-5:OOPM - ExCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> r. <br /> EHD 4.6.02-006 <br /> IMM5 <br />