Laserfiche WebLink
v <br />- ,..JOA UIr <br />. Q <br />T�q-COUNT Y— <br />'r.'!�?e GreatnesL.ffrvs here <br />_ a�►�� _NEP <br />Envir®nmen' ' Health Department <br />PUBLIC REC_ rM RELEASE APPLICATION <br />EHD LOG NUMBER: 67qqo <br />U5i <br />Staff will contact y an ippointMent d d time to review the requested <br />SIGNATURE OF APPLICANT DATE l <br />1. List up to ten addresses in the space below. Add ss nge T be accepted. Select the type(s) of files from the <br />list below by checking the appropriate box(es). At least one file type 1VI T be selected. Fax to (209) 464-0138, mail to the <br />address indicated below, or email to info(a)sicehd.com. Applications received after 3:00 pm will be processed the next <br />business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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 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 $152 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 to <br />ENVIRONMENTAL <br />FILE ADDRESS <br />HEALTH DEPARTMENT <br />(Specific addresses <br />only, address ranges will not <br />be accepted) <br />EHD USE ONLYFILES <br />nderground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP), <br />Other Cleanup Site (Non -LOP) <br />� � <br />❑CONSUMER <br />Hazardous Waste <br />❑ DAIRY <br />Tiered Permitted Facility <br />2 <br />Aboveground Tank <br />- <br />s <br />❑ PWS <br />e <br />JST (Monitoring / Removal) — A <br />F1 Hazardous Materials <br />Spill / Release Response <br />❑ WATER QUALITY <br />Solid Waste Facility / Vehicle <br />4 <br />F] Food Facility <br />❑ SITE MITIGATION <br />Pool / Spa <br />Dairy <br />5 <br />F-1 Land Use Application Sites <br />s <br />❑ HOUSING <br />Septic Pumper Truck / <br />Yard / Chemical Toilets <br />Wastewater Treatment Plant <br />❑ CUPA <br />Housing Abatement <br />7 <br />AST/HM/HW <br />Motel/Hotel <br />❑ CUPA <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />8 <br />UST <br />❑ Tattoo/Body Piercing <br />❑ SOLID WASTE <br />Waste Tire <br />g <br />Complaint <br />ther (Please Specify): , <br />ACCOUNTING <br />***BOXED AREA - EHD USE ONLY*** <br />ro Vi <br />Lok) <br />NJ Records provided by Staff -PPR Complete. Staff Name: P—LeAA EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />