Laserfiche WebLink
Hpr 01 11 04: 48p P. 1 <br /> 1 • <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1 0 <br /> 600 East Main St. Stockton, CA 95202-3029 $� <br /> 4 ,�01(Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd J <br /> APR 4 PUBLIC (RECORDS RELEASE APPLICATION <br /> pE BUSINESS/AGENCY: JLI�"�'�\ a�U �nG <br /> ADDRESS: 1� CITY/STATE/ZIP: l,Qq� t�n L-(y SEi <br /> PHONE(1): C' �j - )34-(nLt�O _ PHONE(2): q,35-q?�j-SISO FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE�R�E� �UE3T-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> e,qq! <br /> SIGNATURE OF APPLICANT l_. 1(� i-(L.iV DATE_3-,-Qq--2_n j( <br /> Electronic Information: ❑List❑ Nlap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2 1 tnit <br /> nit2 <br /> 3. .` <br /> 5. --- nit 3 I <br /> 6. <br /> --------- - ZUnit4 <br /> 7. <br /> 8 -- <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Dale Range of Information Requested: From ' <br /> I ( I l a q 11 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE � '1 <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONR)RINGIREMOVAL) ❑DOG KENNEL ❑DAIRY r <br /> ®HAZARDOUS WASTE GENERATOR El CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT1,1/l`�I\ <br /> ❑TIERED PERMITTED FACILr'Y ❑MOTELINOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS `^ <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILIT) ❑OTHER(PLEASE SPECIFY) <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 addra<.ses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least on,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 Miles will be held fora 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 retumec 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 /> r ' EHe USE ONLY <br /> n <br /> EHD Ca-06 <br /> OIRBnO <br />