Laserfiche WebLink
D T i5 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> EAfVIIiQFiMailf4l.FiEA- <br /> elephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd Oq7(.P) <br /> PERMITl�WCE6 "' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: \vV kLTI;'E� K-N CL.t-N BUSINESS/AGENCY: mit"e >L ✓• <br /> ADDRESS: p.b:,X--7(-3(W] CITY/STATE/ZIP: S t��CAR 2,c57a <br /> PHONE(1): X34-7'S-JPS S`6,(� PHONE(2): FAX OR E-MAIL:W 0,1kr-0. ei1Cttl Ger V, <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑!CHECK BOXTO'EXPEDITE REQUEST,$139 FEEr(CASH-ORICHECK ONLY)-IREQUESTIRROCESSED,IN 3'BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� ��� DATE �0 (.*(t(D <br /> 1. List up to ten addresses in the ce below. Select the type(s)of files from the list below by checking thb ap ropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not retumed 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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From L(_ Ai/,51V- to <br /> ENVIRONMENTAL <br /> IHEALTH DEPARTMENT FILE ADDRESS <br /> (FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City I,o (' <br /> �� <br /> CLEANUP SITE(LOP) CONSUMER <br /> �, <br /> t <br /> HER CLEANUP SITE(NON-LOP) f 5'v ` ( <br /> �QT <br /> KI HAZARDOUS WASTE <br /> /—'` L� ❑DAIRY <br /> TIERED PERMITTED FACILITY <br /> BOVEGROUNO TANK <br /> -UST (MONRORING I REMOVAL) ^\ ❑PWS <br /> HAZARDOUS MATERIALS <br /> XS PILLIRELEASE RESPONSE <br /> 7 SOLID WASTE FACILITY I VEHICLE , WAicR QuA! v <br /> ❑FOOD FACILITY <br /> ❑POOL/SPA SITE MmGATION <br /> ❑DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> CCC 0-I -i u \ <br /> SEPTIC PUMPER TRUCK/ C]HousING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT <br /> CUPA <br /> HOUSING ABATEMENT <br /> MOTEL/HOTEL <br /> ❑CHICKEN RANCH I DOG KENNEL "'PA-UST <br /> ❑MEDICAL WASTE FACILITY 8 <br /> TATTOOIBODY PIERCING <br /> WASTE TIRE ❑SCUD WASTE <br /> 9 <br /> F�COMPLAINT <br /> OTHER(PLEASE SPECIFY): <br /> Ac;ouNnnG <br /> 10 <br /> —BOXED AREA•EHD USE ONLY— <br /> E3 Records provided by Staff-PPR Complete. Scarf Name: L LgjL <br /> EHD 48-06 <br />