Laserfiche WebLink
4qECE1VED <br />DATE RECEIVED SAN ®OAQUIN COUNTY EHD LOG NUMBER <br />DEC. 3 0 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br />E RCIV EN7�LH L 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />PERMMSERVICES fephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />,--,\ PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: L t/` USINESS/AGENCY: "f ( D <br />ADDRESS: CITY/STA E/ZIP: C� <br />PHONE (1). _ e PHONE (2): FACSIMILE: <br />Prase allow 10 business day`s from date of application submittal for the records to be available. <br />Staff will contact you to arrange an appy tmenA date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST -$FEE �AS ( =ECKONLY)REQUEST PROCESSED IN 3 BUSINESS D YS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS EHD USE LY <br />Specific Date Range of Information Requested: From E013 to <br />ENVIRONMENT L HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ MEDICAL WASTE FACILITY <br />❑ SOLID WASTE FACILITYNEHICLE <br />THER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />❑ WASTE TIRE <br />` UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ FOOD FACILITY <br />❑ DAIRY <br />ABOVEGROUND TANK <br />❑ CHICKEN RANCH/ DOG KENNEL <br />❑ WASTEWATER TREATMENT PLANT <br />,[Z[HAZARDOUSWASTE/HAZARDOUS MATERIALS <br />❑ MOTELMOTEL <br />❑ PUMPER TRUCK/YARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING <br />�I/lj�/� <br />\EfOTHE^ "'LEASE SPECIFY) <br />Milm10 <br />#�NL�.��'_:�jr <br />Specific Date Range of Information Requested: From E013 to <br />ENVIRONMENT L HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ MEDICAL WASTE FACILITY <br />❑ SOLID WASTE FACILITYNEHICLE <br />THER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />❑ WASTE TIRE <br />` UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ FOOD FACILITY <br />❑ DAIRY <br />ABOVEGROUND TANK <br />❑ CHICKEN RANCH/ DOG KENNEL <br />❑ WASTEWATER TREATMENT PLANT <br />,[Z[HAZARDOUSWASTE/HAZARDOUS MATERIALS <br />❑ MOTELMOTEL <br />❑ PUMPER TRUCK/YARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING <br />ZoMPLAiNTIRESPONSE RECORDS <br />\EfOTHE^ "'LEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS /'7 5 <br />1. List ur) 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) 464-0138 or mail to the address indicated above. Address✓s//%-T <br />ranges will not be accepted. Applications received after 3:00 pmwill be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact END at the number noted above. <br />3. -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 />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 $125 deposit prior to review. ***BOXED AREA- EHD USE ONLY*** <br />-I I Im ror 043 -1 ,,vow est <br />❑ Records provid d by Staff -PPR Co plete. Staff Name: <br />EHD 48-08 J n 4128/14 <br />/ <br />%% G/i/7 / S <br />