Laserfiche WebLink
SAN d DA U 1 NRF-(;FIVF-4-vi,onmenW Health Department <br /> ' -- COUNTY— APR 2 5 201) PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness yrc;+s her- <br /> ENVIRONMENTAL <br /> erENVIRONMENTAL HEALTH <br /> EHD LOG NUMBER: <br /> •APPLICANT: AL ( w,,\ BUSINESS/AGENCY: <br /> ADDRESS: rZ l� EG'S (e CITY/STATE/ZIP: qtr (A qt�:zNO <br /> PHONE (1): 0' 35 8`( PHONE (2): 2_01 ' 36j X301 FAX OR E-MAIL: <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 /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 mail to the <br /> address indicated below, or email to infoliDsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 deposit prior to review. 'J <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) —l <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( P y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) r CONSUMER <br /> .Other Cleanup Site(Non-LOP) l 1 G� T J I I`��� <br /> Hazardous Waste / <br /> C [3 DAIRY <br /> Tiered Permitted Facility 2 11 II rn� <br /> Aboveground Tank K op <br /> WUST (Monitoring/Removal) ❑PWS <br /> Hazardous Materials 3 <br /> )]Spill I Release Response <br /> Solid Waste Facility/Vehicle 4 41111 I I1b ATER QU.InY <br /> Food Facility <br /> Pool/Spa NrSITE MITIGATION <br /> E] Dairy s <br /> Land Use Application Sites <br /> Septic Pumper Truck/ ❑HOUSING <br /> 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant p CUPA <br /> ❑ Housing Abatement Y ASTIHMIHW <br /> ❑ Motel/Hotel <br /> Chicken Ranch/Dog Kennel COPA <br /> Medical Waste Facility 8 UST <br /> Talton/Body Piercing <br /> El SOLID WASTE <br /> ❑Waste Tire e <br /> E] Complaint <br /> Other(Please Specify): p Accou"NG <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*- <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 484e <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />