Laserfiche WebLink
51- <br />c3f <br />DATE RECEIVED SAN JOAQUIN COUNTY <br />IC C <br />I VANELJ <br />ENVIRONMENTAL HEALTH DEPAR11viENT <br />JAN 2q 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />17 <br />oq4, <br />EHD LOG NUMBER <br />BUSINESS/AGENCY: Crt01..tCk`T60_VL <br />�i CITY/STATE/ZCIP: <br />PHONE (1): bI 1—_)" 3' �PHONE (2): -IVI '/V 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 EXPEDITER ST - $125 FE ASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINE S DAYS <br />SIGNATURE OF APPLICAN C/ — / DATE —P_ i <br />Electronic Information: E]Lis ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />El Unit 1 <br />Street #11 <br />Street Name <br />City <br />1. <br />� S <br />JJ <br />H <br />n <br />2. <br />-2 -Z- <br />23.CP1 <br />3. <br />Q1 <br />"Li.� <br />WWI <br />Unit 3 <br />4. <br />5. <br />❑,U t 4 <br />To view the HMMP'(Hazardous <br />Materials Management' Plan) go to the ❑ Unit 5 <br />following website, www sjoesdata.org <br />❑ Unit 6 <br />6. <br />7. <br />8. <br />9. <br />10. <br />Specific Date Range of Information Requested: From t1A 1-1 U to ,(JY t �G►1 i <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />jONDERGROUND TANK (UST) CLEANUP SITE (LOP) MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE I <br />❑THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT [:]WASTE TIRE fISS f3 <br />F <br />UNDERGROUNDTANK(MONITORINGIREMOVAL) F1 FOOD FACILITY [:1 DAIRY f �' 5t/o/%3 <br />ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />&PAZARDOUSWASTEIH ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA N LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5: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 $125 deposit prior to review_ ***BOXED AREA - EHD USE ONLY*** <br />I <br />❑ Records provided by Staff -PPR Complete. Staff Name: <br />GIA1•f <br />EHD 46-06 <br />