Laserfiche WebLink
NeuEHD LOG NUMBER <br /> Rt <br /> SAN .�OAQUIN COUNTY <br /> Svc 14 9NVIRONMENTAL HEALTH DEPARTMENT 50qq <br /> 600 East Main St. Stockton, GA 95202-3029 <br /> one: (209)468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br /> RONMTF-IaviV OSS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BLISINESSIAGENCY:ii ,1e+ p ��. <br /> ADDRESS, _ 3zt3*S eou ¢ e, t, _ GITYISTATEIZiP: <br /> PHONE 11?= q - a-A36 PHONE(2); _ FACSIMILE: ati,� <br /> TENrA IVE'APPOINTMENT DATE: Tirne- <br /> (Please allow 10 business dbys from date of application submittal-•Tenfavve only-must be corrtirmed) <br />{ ❑CHr=CK BOX TO EXPEDITE REQUEST A122 FEE(GASH OR CHECK ONLY)-REQUEST'PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT g,r � DATE <br /> i, Electronic Information: ❑List❑Map—Description: if <br /> 4. <br /> FILL=ADDRESSI' EHD USS ONLY <br /> Street ft Street Name city ! _ it 1 <br /> 1. <br /> 2- S. Mor T; <br /> nk 2 <br /> 3, 5-s-o3 C !1 11 <br /> 4' "IS1' nit 8 <br /> 5• (,2sC>----,. r'IffAIX <br /> (! <br /> Unit 4 <br /> 7. <br /> _ O Unit 5 <br /> nits J <br /> Specific Data Ranpn of information Requested: From Oce to <br /> ENVIRONMENTAL HEALTH 0FPARTMENT FILES <br /> 1NDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT D WASTE FACfLiTYIVEHICLE <br /> �THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY �pSTE TIRE <br /> y.DERGROUND TANK(MONITORINGIREMOvAL) ❑DOG KENNEL RY <br /> ARDOUS WASTE GENERATOR ❑CHICKEN RANCH VSTEWATER TREATMENT PLANT <br /> TIEREDPERMnTEpFACILITY <br /> ❑MPTELIHOTEL FLAND <br /> APERTRUCKIYAROICHEM[CALTOILETS <br /> ]TATTOOIBODY PIERCING L! '%WsPA 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-5:00P M(EXCLUDING HOLIDAYS) <br /> 1. List up to tan addresses In the space above. Select the type(s)of files from tHa list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to 12091 Ji,�4.0138 or mail to the3ad4rees ladialMd above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applicatlone received after <br /> 3:190 pm will be processed the next business day, { <br /> 2, The EHD will notify the applicant if any EHb files exist. An appolntment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> I should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately avallable 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'IEHD staff at the expense of the appllcant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> END USE ONLY <br /> i <br /> EMn O r"1O <br /> I00/L001A xvi 8E:0L LLOZ/lel/80 <br /> C <br />