Laserfiche WebLink
UH It Itt(;tIVtU 40 EHD LOG NUMBER <br /> 4 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALT11 DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> JP Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: d /V ' E VAIDS 'BUSINESS/AGENCY: <br /> ADDRESS: /e p CITY U:_- �L,�7`Z STATE � �%oZ J <br /> PHONE(1): - PHONE(2): 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. FEE(CASH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic <br /> Information 13List E3Map-Description <br /> FILE ADDRESS EHD USE ONLY <br /> street I Street Name City <br /> 1. W . A F -,4 <br /> 2. El Unit 1 <br /> 3. ❑ Unit 2 <br /> El Unit 3 <br /> 6. <br /> 7. ❑ Unit 4 <br /> \\a <br /> 5.0 F1 Unit 5 <br /> L9. <br /> 10. - Unit 6 <br /> Specific Date Range of Information Requested:From � �� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENTOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY ❑WASTE TIRE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR `CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOoIBODY PIERCING ❑POOLISPA 11013 <br /> LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY �OTHER(PLEASE SPECIFY) / 11Uf_TW <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOUOAYS. <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 END.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 fora maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by END 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 /> �J <br /> EHD 48-06 <br /> 10/31/2006 <br />