Laserfiche WebLink
DATE RECEIV)=D EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -5/-2V, 300 yl 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Troy COX BUSINESS/AGENCY: ESIS HSE <br /> ADDRESS: 2708 Ione Street CITY/STATE/ZIP: Sacramento , CA <br /> PHONE (1): 916 -971-4012 PHONE (2): FACSIMILE: <br /> TENTAT/VE*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-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 5 -21-12 <br /> Electronic Information: 2 List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. 17641 French Camp Road Ripon <br /> 2. f C:iT;Mo u;}��, <br /> ❑Unit 2 <br /> 4. ./ <br /> 5 Unit 36. �� <br /> -,EI Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From 19 4n to 2 n 1 2 <br /> [3 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES /) <br /> [3UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �'�tJJ11 <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY El WASTE FACILITYNEHICLE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL)V4— ❑DOG KENNEL ❑WASTE TIRE <br /> ® El DAIRY <br /> HAZARDOUS WASTE GENERATORPLANT <br /> �-- ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANTe <br /> ElZ�fa` <br /> TIERED PERMITTED FACILITY E]MOTEL/HOTEL E]PUMPER TRUCK/YARD/CHEMICAL OILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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 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 /> Futuure file reviews by the same applicant may require a$125 deposit prior to review. ; I <br /> Vl H , Qf✓i "l <br /> EHD 48.06 (Lp <br /> 8!1111 <br />