Laserfiche WebLink
DATE RECEIVED EMD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMIENTAL HEALTH DEPARTMENT . - <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone: (209)'468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgtehd <br />PUBLIC RECORDS RELEASE APPLICATION i <br />APPLICANT: BUSINESSIAGENCY: \ ' <br />ADDRESS: <br />PHONE (1): -2 7"" _ U PHONE (2): (0 I FACSIMILE: 2-3 -33' � <br />TENTATIVE* APPOINTMENT DATE: 3 / Time: 3 <br />(Please avow"business ys from date of cats submittal -*Tentative only -must be confirmed) <br />13 CHECK BOX TO EXPEDITE REQU T - 5.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS. <br />SIGNATURE OF APPLICANT _ DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # street Name city ❑ Unit -1 <br />2. <br />. Unit 2 <br />3. <br />❑ Unit 3 <br />4. <br />S. <br />❑ Unit 4 <br />6. <br />❑Unit 5 <br />-- --T� -- <br />_ <br />8. <br />-9. <br />❑ Unit s <br />Specific Date Range of Information Requested: From ( _ `y to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />(:3 UNDERGROUND TANK (UST) CLUMP SITE (LOP) 13 HousiNe AsATmEnT 13 SOLID WASTE FAC ENICLE <br />CI OTHERCLEANURSITE (NON -LOP) ® FOLD FACILITY 13 WASTE TatE <br />❑ UNDERGROUNb TANK (MONtiORING/REMOVAIa ® DOG KEtItIEL E3 DAIRY <br />O HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH O WASTEWATER TREATMENT Puwr <br />❑ TIERED PERMITTED FACILITY ® MOTELIHOTEL 13 PumpER TRucRlYARDICHEM TOaETs <br />O TATr001BODY PIERCING 13 Poa1SPA 13 LAND USE -APPLICATION SITES <br />O MEDICAL. WASTE FACILITY ❑ OTHER.(PLEASE SPEc� <br />WEU. AND SEPTIC PERmrr RECORDS ARE AVAPABI £ FOR REvIEW - MONDAY -FRIDAY 8:00 AM-5:00PM • . EXcLuDiNG HOLIDAYS. <br />1. Ust up to ten addresses in the space above. Select the s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (2 1464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Appiications 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 fora mum 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. , r <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 $95.00 deposit prior to review., <br />r � <br />