Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> EN*DNMENTAL HEALTH DEPARTONT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd I l , <br /> L <br /> PUBLIC RECORDS RELEASE APPLICATION (((•••/// t {{„//(�,•r <br /> APPLICANT: „� ` ��, <br /> BUSINESS/AGENCY: Lry- <br /> ADDRESS:— <br /> PHONE(1): PHONE PHONE(2): <br /> FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: " <br /> (Please allow 10 business days from date of application submittal••TentaBve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU -$93.00 FEE( H OR C},{�CK ONLY)Y)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE � - o6 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronicilists/maps) <br /> FILE ADDRESS <br /> Street III Street NameCit EHD USE ON Y <br /> Gt/, c L <br /> 2. 30 oL 4r 5,�curyL, , L <br /> 3. <br /> 4. 3 a 1 <br /> 6. r <br /> 7. ,r <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 2'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> -M OTHER CLEANUP SITE(NON-LOP ❑SOLID WASTE FACILITYNEHICLE <br /> 16 UNDERGROUND TANK(MONITORING/REMOVAL O FOOD FACILITY ❑WASTE TIRE <br /> -2f HAZARDOUS WASTE GENERATOR ) DOG KENNEL ❑ DAIRY <br /> ❑TIERED PERMITTED FACILITY ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TATTOOIBODY PIERCING ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑MEDICAL WASTE FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OoPM - 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 application. 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 />