Laserfiche WebLink
DATE v_�o SAN JOAQUIN COUNTY EHD LOG NUMBE <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> L 5 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 'v �ne: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehPUBLIC RECORDS RELEASE APPLICATION <br /> H <br /> pER <br /> APPLICANT: , p BUSINESSIAGENCY: e kf t Yl_r ivt 22 , <br /> ADDRESS: 5- 1 -t r f;PL-e vde 10 CITYISTATE/ZIP: I�f��c-� C( �R � C-A :::i (o <br /> PHONE (1): l cPHONE (2): 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-$77!2=:7=. <br /> OCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE f <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Named n City El Unit 1 <br /> Q 2. ,� ci `'10 � icG ) 1L �� 5���,'� I(' P"cr't' ❑ <br /> . v� � Unit 2 <br /> 3. <br /> 2 22L <br /> CD <br /> 4' ,' I ..:�,�i ( f��. �r '� i'1 Unit 3 <br /> 5. <br /> 6. /A/ J! unit 4 <br /> O- 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ol <br /> T ER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> AB GROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑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 up 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$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY`** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-66 4128114 <br />