Laserfiche WebLink
03/29/11 09:44 FAX ___. • X001 <br /> EHD LOG NUMB <br /> r ,,,,, <br /> D SAN JOAOUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2 9 Z011 600 East Main St. Stockton;CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION �a <br /> APPLICANT: KEv1N ��xG (� T�I iBUSINESSIAGENCY: rtRST 46MYL RttES71}P <br /> ADDRESS: Vcu0 PIyGtLiC AVE CITYISTATEIZIP: 5TOC. _MN CA. gSIoq <br /> PHONE(1): L{61-(a400K 103 PHONE(2):_C 5�— FACSIMILE: t{6(-6310 <br /> TENTATIVE'APPOINTMENT DATE:_ <br /> Time: <br /> (Please allow 10 business days from dato of appliwtlon submittal-"Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQU T-$122 FEE(CASH OR CHECK NLY -REQUEST PROCESSED IN 3 BUSINESS DAYS - <br /> SIGNATURE OF APPLICANT CJS I' DATE J�"e2 S'1 I <br /> Electronic information: E]List XMap-Descriptio : FORM ti 1Jt�C-f2GRLU IN CmR&" TANKS <br /> FILE ADDREss EHD USE ONLY <br /> Street# Street NameCity Unit1 <br /> I. 15at 1 E. FRMON-F ST- Sr6Ckrah) �F I <br /> 2. Ise �J E . �FLEMONT- � ❑Unit2 <br /> 3. (S33 E. LtNt�SA si U 10 <br /> 4. 4yo N_ WIL.SoN WA alta <br /> 5. 4(o W W(LGON WA NU <br /> 6. nit 4 <br /> 7. — <br /> 8, O Unit s <br /> 9. <br /> 10. f ❑Unite <br /> Specific Date Range of Information Requested: From <br /> ❑ Tto A'es62,' <br /> ENVIRONMENTAL HE9� PARTMENT FILES �LyERCROUNOTAP((UST)CLSITE(LOP) ❑HOUSING ENi ❑$OUFACILRYNEHICLE fUN1' `2 <br /> 0CCJn <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTETIRE G/r <br /> , <br /> ly' <br /> 0 ,1 <br /> �J`54 UNDERGROUND TANK(MONITORINGIREMOVAL)K, ❑DOG KENNEL ❑DAIRY �C\ <br /> (, AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Lot-II TATTooTiERm BODY P ERC NGLIRmuEo TM F]POO SPAC]MoTELIHOTEL _ El LAND USE APPLICE]PumPERTRUCKIYAT O/N SITEB AL TOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyiEw::MONDAY-FRIDAY 8:00 AM-5:OOPM(ExcLUDINO 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)464-01_a 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 appDlntment for review will be conflrmed 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 hot 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> d <br /> - II II t sra4lr <br /> EHD 40-00 07129110 <br />