Laserfiche WebLink
r <br /> SALT JOAQUI COUNTY 1-HU 1_111-4 NUMBER <br /> E 1 MENTAL HEALTH DEPARTML <br /> 304 East Weber.Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 9RO&ENE L, ' E Y/d0 LI>S BUSINESS/AGENCY: <br /> ADDRESS: �ti�I� (.y• lJ N A!n/E 1Q D CITY_5ry G,-7-a') STATE_C6__�.5-A 0& <br /> PHONE(1): C 65t 0-1) 4 9a - ,p090 PHONE(2):_ (�®�� `t`lo`t –f D�," FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ` z..` � DATE 3Z//0 6 <br /> Electronic 13 List ❑ Ma Description <br /> InformationP' P <br /> FILE ADDRESS <br /> Street# Street Name city EHD USE ONLY <br /> 1• a- a �, Uni <br /> ❑ t 1 <br /> 2. �'.� l I- .3. 9-o -/ <br /> 4. ie 04 vggx A ❑ Unit 2 Q�S <br /> 5. ❑ Unit 3 <br /> 6. \i <br /> 7. ❑ Unit 4 <br /> 8. <br /> s. nl <br /> 10. %etnit 6 <br /> Specific Date Range of Information Requested:From / 9 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> ❑ UNDERGROUND TANK�+(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> <JGNEMT�R�+ �HICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELJHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in.the space above. Select the pe(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)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 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 /> EHD 48-06 <br /> 10/31/2006 <br />