Laserfiche WebLink
10/08/2010 09:18 91664E ADR PAGE 01/0' <br /> CS�910 EHD LOG NUM ER <br /> RIE <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> l� . '�� <br /> bi P( 600 East Main Street, Stockton, CA 95202-3028 <br /> v'R��1VtENj Hglkklephone: (209) 468-3420 Fax: (209) 464-0138 Web; Www.Sjgov.org/ehd <br /> E�pERM1�fISERVIG�s PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �E-T,,I tg lg �'1A CjtJ BUSINF-SS/AGpE'NCY: NF— <br /> L11) <br /> ADDRESS: CltylstateZi <br /> PHONE(1): ��' Q PHONE(2' FACSIMILE, <br /> TENTATIVE"APPOINTMENT DATE: Time:� f)f) <br /> (Please allow 10 business days from data pplication submittalo a -*7entaf/ve 0Illy-must be confirmed) <br /> ❑ CHECK BOXTO EXPEDITE REQ T-$105 FE ('ASH OR CHECK ONLY)-REQUEST PROCESSEnIN 8 SIN S3DAY�S,�ICNATURE•i=APPLICANT - �"�- DATE. �L) <br /> Electronic Information: D List❑ Map-Description. <br /> FILE ADDRESS END USE ONLY <br /> Strvct# Street Name Clty ❑ Unit 1 <br /> )' 1. 11 G deh <br /> 2, C <br /> 3, Weunit 3 <br /> Unit 4 <br /> 7. ❑ Unit 6 <br /> t;�Gj t tUnit 6 <br /> Lio—-L129-0 <br /> Specific Date Range of Information Requested:From `p��(�zi _ toU <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HousiNG ABATEMENT %SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ©FOOD FACILITY WASTE"TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL)tr ©DOG KENNEL kXIIAIRY <br /> ❑CHICKEN RANCH OWASTEWATERTREATMFNT PLANY <br /> 16 TIERED P R WASTE GENERATOR In MOTEL 1710-ML d PUMPER TRUCK/YARD/CHEM TOILETS <br /> A TIERED 113ODY PIV FACILITY ❑POOL/5PA ❑LAND USE APPLICATION S ms <br /> �,TATTOQ160DY PIERCING <br /> Ae ❑MEDICAL WASTF-FACILITY D OTHER(PLEASE SPECIFY) <br /> q S <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAW-E FOR REVIEW-MONDAY-FRIDAY 8:00 AM-6:0 <br /> OPM - ExcLUDINO HOLIpAY3. <br /> 1 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 aboyo, 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 a 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> r --10 . Gtr t 31 <br /> PUBLIC RECVt DS RELEASE APP FORM <br /> EHD 48-06 8/04/0e <br />