Laserfiche WebLink
05/03/2005 15:13 FAX Q001 <br />0 <br />�C <br />EHD LOG NUMBER <br />DAl l 2ECEIVEU ' <br />N JOAQUIN COUNTY <br />v ENVIRONMENTAL HEA THDEPARTMENT <br />304 East Weber Avenue, 3 rd Floor, Stockton, CA 95202-2708 <br />�,,] AY 0 1 ?00%lephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 17Ko --- <br />EWRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �i.^_ ���^-Ile' - BUSINESS!AGENCY: c�ltC�!�, n'jir-71r]V1/7P(/� <br />ADDRESS: __ <br />PHONE (1): ? % "Z�CI 2 354- PHONE (2) 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 REQUEST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />EI T DISTRIBUTION 0 Unit 1 0 Unit 2 0 Unit 3 0 Unit 4 ❑ Unit 6 0 Unit 6 13 Other (electronic/lists/malls) <br />FILE ADDRE <br />Street A Street Name <br />_ mail! <br />USE ONLY <br />IN. nI ILI al ' I III .::.w 1.%WE <br />0�IMININ 110110111 H11111C <br />��uuu low ■um1m1m11mIw111mm <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />�! UNDERGROUNII TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />EI THER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY ❑ WASTE TIRE <br />L -I 1I NDERGROUND TANK (MONITORINGiREMOVAL) ❑ DOG KENNEL ❑ IRY <br />Sli Ail <br />H AZARDOUS WASTE GENERATOR 171CHICKEN RANCH MASTEWATER TREATMENT PLANT <br />C1 -TIERED FERMI?TED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />177 fATTOOiBODY PIERCING 0 POOLISPA M LAND USE APPLICATION SITES <br />❑ fVIEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM -EXCLUDING 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 <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. 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 appiication. 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 />E. <br />EIID 10-07-006 <br />11i -J 6 <br />