Laserfiche WebLink
y�gpF�YFrrEAVC' '� EHD LOG NUMBER <br /> 99_lCii6���'CV7��1►��7 SAN JOAQUIN COUNTY <br /> AUG 0 7 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,.Stockton, CA 95205-6232 l7 v <br /> ENVIRONMENTALI.19 9phone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERUICES PUBLIC RECORDS RELEASE APPLICATION �! <br /> APPLICANT: /%T��j4P� � 144- 1.� / /Gj/-/BUSINESS/AGENCY: rk1lI KSCKIle,%fFJC rM., <br /> ADDRESS: �j�h y /=t�xT,41 L `I /'I��LLr CITY/STATE/ZIP: <br /> �%G�.Q R!(Ck(� <br /> PHONE (1): `5'/b" //' 3576 PHONE (2): J'/0— t'/q f-9STF' FACSIMILE: <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 BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)<PEQUEST PROCESSED IN 3 BUSINESS DAYS 011 f-7 <br /> SIGNATURE OF APPLICANT DATE 0q-- u <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> Lf X0,Ci-iMIF - fiKe- M Aw rg* <br /> 2. / '9-6! ✓i r C IAL5t-CD tV ❑Unit 1 <br /> 0 3. dL1 ❑Unit 2 <br /> 2 <br /> QS 4. aVlk+ 1 fI ( ❑Unit 2H <br /> 5. <br /> '/ <br /> 6. (� t� t ©unit 3 <br /> 7. <br /> N(Unit 4 <br /> 8. SITE MITIGATION <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 91UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> V OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT [j WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ElFOOD FACILITY ElDAIRY <br /> U/iBOVEGROUNO TANK ❑CHICKEN RANCH/DOG KENNEL ElWASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY O2OLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOBODY PIERCING NI COMPLAINTIRESPONSE 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 un 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.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 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$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> 7-t`i - 1,AWrX We "Vo(?h !evie',,.J, p• eJl w^. ���V� <br /> 6 ,AA Glee� b>A Yp v_ e_ kve <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 711115 <br />