Laserfiche WebLink
06/27/2006 10:38 FAX X002 <br />DATE REcelvEo EHD LW NUMBERSAN JOAQUIN COUNTY <br />ENvrRoNmE4NTALHF,ALTHDEPARTmENT <br />304 East Wcber Avenue, P Floor, Stockton, CA 95207-2708 <br />Telephone: (209) 468 37420 Fax: (209) 464-0138 'Web: %, ww.sjgov.orr,/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 151' &11&&& BUSINESSrAGENCY:Leoz &Dt_, <br />ADDRESS: f2&I 11 W . LA A5 1 -m <br />PHONE (1) .�e°.t'#.°" � 3 PHONE (2): FACS11ML.E: .,_ 'iA 9 1- :71-v <br />TENTATIVE* APPOINTMENT DAM rem: <br />(Please allow 10 businm days from date of app1lim ion submittal - °T-entstrve only - must be centirmd) <br />® CHECK BOX TO EXPEDITER U - $93A0 F ( HECK ONLY) . REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPUCANT DATE Im'7s <br />UNIT OISTRIBU'a ION d Unit Vff Unit ❑ Unit 3 ❑ UnR4 ❑ Unit a ❑ Unit s ❑ Othar (aIecVon1dII$ '9linaPs) <br />Specific Date Range of Information RequeeWd: From to _ <br />ENVIRONMENTAL HEALTH DEPARTMENT FIDS <br />)UNDERGROUNDTANK (UST) CLEANUP SITE (LOP) ❑ HOUSBIG AL3ATMNT ElSOLID WASTE FAc3UTY(V'EMCLE <br />OTHER CL@ANUP SITE (NON-t,OP) Q FOODF,.A�C,.IL,.ITY ❑ WASTE TIRE <br />RO <br />UNDERGUNDTANK(FJ0W X1NG1REM*VAL) 0 Doe-,yG7ML ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ cmim RANCH ❑ WASTEWATER TRk-ATMENT PLANT <br />❑ TIERED PERWTTED FACILITY E3 Mo7ojHOTEL Q PUMPER TRUCKtYARWCHEM TOILETS <br />a TATTOoIBODY PIERCING 0 POOUSPA ❑ LAND USE APPLICATION $RES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASESPEC►@Yi <br />WELL AND Semc PERMIT RE== ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY & AM-a:00Pv - EXCLuaING HOU13AYS. <br />I. Ulst up to ton addresses in the space above. Select the type(s) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (2091 464-0138 or mail 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 businm day. <br />2. The EFTA will notify the applicant If any EHO files exist. An appointment for review will be confirmed <br />approximately ten (10) days after receipt of application. The flies 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 avaliabim <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 />EKG 4"2-M <br />1M4106 <br />