Laserfiche WebLink
•w`II icR w IL.Ltl rrn a25 U4li y ERM WEST WC x001/001 f� <br /> ' ER�1�WE® EHD LOG NUMBER <br /> SA14 JOAQUIN COUNTY JS7 <br /> JUL 12014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> T lephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.Sjgov.org/ehd <br /> ENVIRONMENTAL HEALTt� <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a 1 (gtA Q� f]S re-y BUSINESS/AGENCY <br /> ADDRESS: ��--) II� MVJ., `5Jl <f)6 CITYISTATE/ZIP: W11 KL - (-y4c -. c4 961!Sq"1 <br /> PHONE (1): QZ5. Z,'�j PHONE (2): 'ASFI.1' OS. !nd2FACSIMILE: gz;. 9W1.9%* <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-5125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> FElectronic Information: [] List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit <br /> 1. Co- M <br /> 2' n Unit s <br /> 3. / <br /> 4. LQ Unit 3 <br /> 6. <br /> 173 Unit a <br /> 7. <br /> 8. <br /> ❑ Unit 6 <br /> 9. <br /> 10. - p] nits <br /> Specific Date Range of Information Requested: From to / <br /> ENVIRONMENT,AL HEALTH DEPARTMENT FILES ,t) <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILnYiVE111CLE <br /> OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑WASTE TIRE <br /> IDERGROUND TANK(MONITORINGIREMOVAL) E]FOOn FACILITY ❑DAIRY <br /> OVEGROUND TANK E]CHICKEN RANCH/DOG KENNEL ZfASTEWATER TREATMENT PLANT .pry <br /> [ RDOUS WASTE/HAZARDOUS MATERIALS [:]MOTEUHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> FRED PERMITTED FACILITY ❑ OOUSPA ❑LAND USEAPPLICATION SITES <br /> [-]TATTOOISODY PIERCING CCOMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AAI-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above. Select the typo(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 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 files axist. An appointment for reviewwill 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 Nle not retumed 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$126 deposit pr(or to review. —9OXED AREA-EHD USE ONLY' <br /> til u ? ta)J f HfhMP F9/e dfc) <br /> Oo03. 7 710-7'7 2011cle. 31' <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> END 16-0 d2elld <br /> Received Time Jul. 1. 2014 12:56PM No, 6479 <br />