Laserfiche WebLink
DATERECEIVED SAN JOQUIN COUNTY�J EHD LOG NUMBER <br /> REEVED ED ENIVveZONMENTALHEALTH D PARTOENT <br /> JUN O 2 LU), 600 East Main St. Stockton, CA 95202-2708 <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e <br /> ENVIR(uIT FR ICES PUBLIC RECORDS RELEASE APPLICATION <br /> P-F�IA�-�Efi�'FS ,/ � <br /> APPLICANT: 1 j'�f I I A1< I&LYVI BUSINESS/AGENCY: '4Hjyl 1/LPt1 <br /> ADDRESS: � � �—r Ac1f101<' '!Ue /W CITY/STATEIZIP: Spe—flI <br /> PHONE (1): "12y— 2800 PHONE (2): 2 FACSIMILE: Lf7 Y� sGs <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-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l VLA1 1 DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> r t. 351 N av7 Sfi�n^ S <br /> 2. 00 AUy &'Z_ Shy'1 hA — ❑ Unit2 <br /> 3. /6 <br /> 4. <br /> t3 <br /> 5. <br /> 6. <br /> ZUnit <br /> 7. <br /> Or <br /> 8' ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From 114 Z Gcil/(4-0-M to <br /> ENVIRONMENTALHE TLA H DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP)NON-LOP ❑HOUSING AB ❑SOLID WASTE FACILITYNEHICLE ATEMENT �i ' ' 'e5 (((���. <br /> � <br /> OTHER CLEANUP SITE <br /> ( ) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR a - ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT rJ�OI tj( <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATToolBODY 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 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 <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications 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 for a maximum 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. <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$115.00 deposit prior to review. <br /> END USE ONLY <br /> ***If you need further assistance please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> fJDO5y8Z i5' /355 <br /> can w.nc <br />