Laserfiche WebLink
❑ SAN �OAQUfN COUNTY EHD LOG NUMBER <br /> � <br /> E `v IoNMENTAL HEALTH DEPARTAIV�NT <br /> fa; �J 5 2009 600 East Main St. Stockton, CA 95202-2708 <br /> T hone: (209) 468-3420 f=ax: (249) 464-0138 Web: www.sjgov.or <br /> Vt <br /> ENVIR0NN1f NTf AND <br /> PERMlTr r�E- PUBLIC RECORDS RELEASE APPLICATION <br /> 4 <br /> APPLICANT: ) BUSINESS/AGENCY: 14 <br /> ADDRESS: <br /> CiTYISTATEIZIP: <br /> PHONE (1)• Q PHONE (2): <br /> FACSIMILE: 4 <br /> TENTATIVE"APPOINTMENT DATE:�� OF � SJ � <br /> (Please allow 10 business days from date of application submittal-`Tentati4onimust beconfirmed <br /> I ❑ <br /> CHECK BOX TO EXPEDITE QUEST-$115 04 F } <br /> (CASH OR CHECK ONLY)-REQUEST PROCESSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICAN <br /> DATEElectronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street <br /> Name <br /> Cit <br /> 1. y ❑Unit 1 <br /> 2. <br /> 3. Uriif 2 <br /> 4. iq <br /> 5. ❑Unit 3 <br /> 6. <br /> 7. ❑Unit 4 <br /> S. 1 <br /> E] Unit 5 <br /> Ca-r to C,! 1n0 <br /> 10. R ie-,, o b-- i epi�tJP.r ,,, ck- N e -�(� l <br /> t i l lP E El unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(USF)CLEANUP SiTE(LOP) ❑HOUSING ABATEMENT <br /> ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SiTE(NON-LOP) <br /> ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH- <br /> ❑TIERED PERMITTED FACILITYASTEWATER TREATMENT PLANT <br /> El TATTOOIBODY PIERCING <br /> ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMfCAL TOILETS <br /> ❑POOLISPA <br /> El MEDICAL WASTE FACILITY E1 LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u 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 feast 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 <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments ten (10) <br /> should be scheduled accordingly. ppointments <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 /> EHO USE oNLY <br /> ***Ifyou need further assistance please contact biane Martinez directly (209)468-3425. Thank You*** <br /> Gilh d0.l�F <br /> T <br />