Laserfiche WebLink
DATE RECEIVED . EHD LOG NUMBER <br /> SAN aJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> RECEIVED <br /> 600 East Main St. Stockton, CA 95202-3029 b <br /> OCT 11 Alephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> ERMPUBLIC RECORDS RELEASE APPLICATION <br /> IT SERVI ES <br /> Uld,owDir P <br /> APPLICANT: SBUSINESSIAGENCY: <br /> ADDRESS: 2/ �4i y�l uN T CITY/STATE/ZIP: 7­lf/2 L o CK e C/+ • F 3$D <br /> PHONE (1): 'Z"r- Y S 9- 14413 PHONE (2): 2 oci_ 6 4 g-/z r 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 125 FEE(CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT s DATE <br /> Electronic Information: ElList El Mai)-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> CA`L) PC vl S 'ITo(hToN <br /> 2. l6 6 HAJQf„ W T, cTIAI3'5 3 S JOr <br /> ❑ Unit 2 <br /> 3. <br /> 4• Unit 3 In <br /> 5. I"4 <br /> 8• Unit 4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ID <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ElHOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> TER CLEANUP SITE(NON•LOP) ElFOOD FACILITY E]WASTE TIRE <br /> ERGROUND TANK(MONITORING/REMOVAL) E]DOG KENNEL ❑DAIRY <br /> Lsyn ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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 ug 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(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 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$125 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 811/11 <br />