Laserfiche WebLink
r Apr. 1. 2015 3 : 06PM No, 0124 P. 1 <br /> r REGEWE® SAN JOAQUIN COUNTY 01 EHD LOG NUMBER <br /> : APR O 1 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1968 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION / P <br /> APPLICANT: n feu �at/a BUSINESSIAGENCY: '0-9 (_1111VI onme% ,T-'33p <br /> ✓tT� <br /> ADDRESS: t <br /> 3 p CITY/STATE/ZIP: (7nyUP4' f N— <br /> PHONE5385--y,30;LPHONE(2): FACSIMILE: S'10 <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-$-$1130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��� ( DATEElectronic information. Elllstl] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> fie Street Name City _ Unit 1 <br /> � litWR,p0e c <br /> 2' (Jt 0 r GtA W Imo a •S -0 ci h fHr t„` { . Unit 2 / <br /> r ry <br /> 4• �E Unita / <br /> 5. <br /> o• r�L'1� l l� Unit4 <br /> 7. <br /> 8• 0 unit S <br /> 9.. <br /> 10. ❑Unit G <br /> Specific Date Range of Information Requeeted: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �RUNDEROROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> y!yOTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WA$TETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOODFACILITY DAIRY - - <br /> ABOvEGROUNDTANK El CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> tR HAZARDOUS WASTNHA7ARDOUS MATERIALS r❑MOYELIHOTEL SPUMPER TRUCKNARDICHEMICAL TOILETS <br /> T--�I <br /> ,TIERED PERMITTED FACILITY r-J POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING RCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLFASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILADLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Ustup to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)484-0138 or mall 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 flies exist. An appointment for review will be confirmed approximately tan(10) <br /> days after receipt of application. The flies 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 /> ( w lAwl� &3-rq-7tul 0E-P, vv-c 'i✓ A e, �&P ll t3 S4wu , <br /> d Records provided by Staff-PPR Complete, Staff Name: <br /> EHD 4&0a Oala7n4 <br /> Received Time Apr, 1, 2015 3: 15PM No. 8439 <br />