Laserfiche WebLink
DATE V �� EHD LOG NUMBER <br /> SAN .10AQUIN COUNTY <br /> Er, _ ,RONMENTAL HEALTH DEPARTh._NT <br /> 0 C T 2 S 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Z/� ���d h l - BUSINESS/AGENCY: <br /> U.ADDRESS: �� � �,<,�5��� CITY/STATE/ZIP:— <br /> PHONE (1): G v -�d 9Z_ PHONE (2): FACSIMILE: _ <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> � ❑ Unit 1 <br /> gZI2. - <br /> 1__- __ ❑ unit 2 <br /> 3. <br /> 4. --- - — - — --- - -- Unit3 fl <br /> 5. ' <br /> 6. - - - _Z�nit 4 <br /> 7. <br /> 8. -- <br /> ❑ Unit 5 <br /> 9. <br /> ❑ Unit <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES CIT <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) F-1FOODFACILITY ❑WASTE TIRE W ( 20 <br /> tl <br /> UNDERGROUND TANK(MONITORING/REMOVAL) F1 DOG KENNEL El DAIRY `1�v -1 <br /> HAZARDOUS WASTE GENERATOR E]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT 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-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 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 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$125 deposit prior to review. <br /> 'l I f 6,0 <br /> EHD 48-06 8/1/11 <br />