Laserfiche WebLink
KIE 6;jp0 408 260 8627 Mar. 28 2011 05:40RM P1 <br /> DATE RECEIVED <br /> toll <br /> �.1 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER 8 <br /> ENVIRONMENTAL HEALTH DEPARTMENT ( ,>� <br /> ENVIRONMENTAL HE 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES-phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT&6n�e <br /> �e, BUSINESS/AGENCY:��j <br /> ADDRESS: CITY/STATE/ZIP:C <br /> PHONE(1); n � PHONE(2) FACSIMILE: 0 <br /> TENTATIVE'APPOINTM NT DATE: FMI Time: () -60 Cr CI I,L <br /> (Please allow 10 business days from data ofapplication Submittal-'Tentative only-must be confnmed) <br /> 1SdCHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 5j I <br /> Electronic Information: [List[]—Map–Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name City - U i 1 <br /> 2 <br /> ❑ <br /> Unit 2- <br /> ' 71 <br /> 4. <br /> — Unit 3 <br /> 6. <br /> nit 4 <br /> ......_.. �]Unit 5 <br /> Unit S <br /> Specific Date Flange of Information Requested: FromH D to <br /> ENVIRONMENTAL HEAL PRT T F S <br /> [�DERGROUND TANK(UST)CLEANUP SITE(LOP) [I HOUSING ABATEMENT EKLID WASTE FAcILfrYNEHICLE <br /> � � <br /> rr�!'OTHER CLEANUP SITE(NON-LOP) E]FOOD FACILITY El TIRE <br /> E4NDERGROUND TANK(MONITORINWREMOVAL)'04 E❑DOG KENNEL ❑DAIRY <br /> Uv H DOUS WASTE GENERATOR El CHICKEN RANCH El WASTEWATER TREATMENT PLANT V <br /> �J <br /> NIERED PERMITTED FACILITY ❑MOTELIHOTEL p PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ©TATTOO/80DY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL 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 typo(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)464-0130 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 prooeSoad 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> -a - aI s <br /> a <br /> o c (p, Al- <br /> " "' # W 3335 EnV,6i0Ari7jflob l,, USTH`IefU/ iIDR .Z 7IbAi1lPZ-1 <br />