Laserfiche WebLink
NOV. 18. 3:26PM KLEINEEEDER, INC. NO. 4612 P. 1 <br /> D EHD LOG NUMBER <br /> U SAN JOAQUIN COUNTY s <br /> tiQ\\ ENVIRONMENTAL HEALTH DEPARTMENT <br /> Nps 600 East Main St, Stockton, CA 95202-3029 1 <br /> �N�,R 4�Telephone: (209)468-3420 Fax: (209)464.0138 Web: www.sjgov.org/ehd <br /> aoN \0�s PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: ���� �g� - CITY/STATE/ZIP: �Q <br /> PHONE(1): ff 7 '567PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Plsese allow 10 business days from da a applicationsubmtel-^Tentative only- unf <br /> must be clrmm) <br /> ❑ <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FE ( AS OR CHECK \kILY)-REQUEST PROCESSED IN$SUSIN 55 AYS <br /> SIGNATURE OF APPLICANT t/ DATE a01 <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> t Street# Street Name City nit! <br /> , , <br /> z. S unitz <br /> 3. <br /> 4. <br /> $ Unit S <br /> 6. <br /> T Unii 4 <br /> 8. <br /> 9 ❑units <br /> 10. <br /> Unit <br /> Specific Date Range of Information Requested: From to <br /> �,./ ENVIRONMENTAL HEALTH DEPARTMENT FILES ,.• IIA1'/ <br /> �RL�.J.,�U ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑$OLIO WASTE FACILrryNEHICLE ah •I('�n <br /> J IJ ER CLEANUP SITE(NON-LOP) ❑FOOD FACILTrY ,�E TIRE - <br /> I�y�NDE�R�GROUND TANK(MONITOmNGIREMOvAL)� ❑DOG KENNEL ❑DAIRY W 11 <br /> O VaMDOUS WASTE GENERAT01X ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 11 <br /> ❑TIERED PERMITTED FACILITY MoTEL/HOTEL Ej <br /> ❑TATTOOISODY PIERCING g pOU�PA 3-5NNO U TRUCKICATION Sins TOILETS <br /> ❑ MEDICAL WASTE FACILITY .Cl LI+nD 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 flat above by checking the appropriate <br /> 60x(95). At least one Nle type MUST be selected. Fax to(2091464-0139 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applloatlons received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the appllcant if any EMD files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 appllcant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> axD usE o9Lv <br /> EHD <br /> 0TM9110 <br />