Laserfiche WebLink
03/29/11 0944 FAX —� r _ _ • 0001 <br /> EHD LOG NUMB <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 29 Z011 600 East Main St. Stockton;CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION �r <br /> APPLICANT: EV(1�1 ���+�!— EIUSINESSIAGENCY:F1R5T-e Mtt. kew -Esmw <br /> ADDRESS: .2aa o Pkgf7(C AVE _ CITYISTATEfZIP: SIocMN CA._ gSaON <br /> PHONE(1): t{6I-&qQ0 X 10 3 PHONE(2):_'{ ��00 FACSIMILE: 146(-63(O <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business clays from data of appllceuon submittal-"Tentatwe only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQU T-$122 FEE(CASH OR CHECK NLY -REQUEST PROCESSED IN 3 BUSINESS DAYS - <br /> SIGNATURE OF APPLICANT DATE 3—-Z S I <br /> Electronic Information: L]List Map-Descriptio FORM. IAAmw-g&Rrt,'LN6 srUm" 7}�NKS <br /> FILE ADDRESS EHD USE ONLY <br /> Street =FR <br /> Name City Unit <br /> 1• 15ati sr SrOcKrahl' f_ ❑UDIt2 <br /> 3 IS 3 S; � <br /> 4. L(L(Q IA�f} nit3 <br /> 5. b WA NO <br /> g, W n <br /> 7. <br /> 8, 11 Unit s <br /> 9. <br /> 10. ❑Unite rryy� <br /> Specific Date Range of information Requested: From to Pr'6SP/J 1"- rIn�ly' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ttooy� r C <br /> 171UNDERGROUND TANK(UST)CLEANUP SITE ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE /� <br /> ` ❑ -72 <br /> OTHER CLEANUP SITE(NON-LOP) I� ❑FOOD FACILITY El WASTE TIRE ( <br /> ,r54 NDEROROUND TANK(MONITORINOIREMOVAL)V. EI Doo KENNEL ❑DAIRYi'4-iNA''MQ,Ct,A+t AZARDOUs WASTE GENERATORK - \ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PA <br /> Nf <br /> _ (( ❑TIEREC PERMfI-IED FACILITY ElMorET/HDTEL ❑PUMPER TRUCKIYAROICHEMICALTOILETs A A�/���1` <br /> 4JIt ❑TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES -`i((`j <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMTY RECORDS ARE AVAILABLE FOR REVIEW::MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> J. List uo to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091484 0136 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 ends[. An appointment fur 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 /> 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 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 8122 deposit prior to review. <br /> END USE ONLY <br /> - d <br /> - II-II . Aoo'- <br /> Emu/a-0s 07128/10 <br />