Laserfiche WebLink
04/12/2007 13:51 2097293076 APERIC INC PAGE 02/02 <br /> DATE RECEIVEQ • SAN JOAQUIN COUNTY L„V <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> pb East Weber Avenue, :(Floor, Stockton,b: 95202-27(w,sjgo8ZS45 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:wTvwsjgov.org/ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �'�i 0 �X'✓t C, J e BUSINESSIAGENCY: <br /> ADDRESS.. ., �� Fy�e�iw N y 4u CA <br /> PHONE(1): 7,211-3075 PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: y '2 07 Time: �o�rd7 <br /> (Please allow 10 business days from dof application submittal•'TemWGve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU T-$9 . EE( OR CHECK ONLY)-REQUEST PROCESSED'IN$BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION P Uni ❑Unit 2 ❑Unit 3 CIUnit 4 ❑ Unit 6 � Unit 6 Other(electroniMllsWmaps) <br /> FILE ADDRESS EHD USE Ot LY <br /> Street y Street Name city <br /> J, 1. BD suer crc nwa e/C <br /> i 2. -e c <br /> 3. <br /> 4. <br /> 6. <br /> 'h <br /> 8. <br /> 7. <br /> 8. <br /> 8. <br /> 10. <br /> Specific Date Range of Information Requested:From��/' to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT SOLID WASTE FACIDTYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE ' <br /> UNDERGROUND TANK(MONRORTNOIREMOVAL) 0 BOG KENNET. O DAIRY <br /> HAZARDOUS WASTE GENERATOR IJ CHICKEN RANCH 0 WADTEwATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY O MoTEUHOTEL In PUMPER TRUCK/YARDICHEm TOILETS <br /> ❑TATTOOIBODY PIERCING O POOLISPA ❑LAND USE APPLICATION SITES <br /> L1 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECK <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Review - MONDAY-FRIDAY 6:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address <br /> indicated abovg, Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD M.DT-0o6 <br /> 11!}]NG <br />