Laserfiche WebLink
10/02/2008 10: 17 FAX 0001/001 <br /> DA "- " \�'rL r EHD LOG NUMBER <br /> -� ���J L-��� AN ,1QAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> OCT �T�elephone; (209)468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br /> E:W1Rc0NfViCij\'T HEALTH <br /> PER NA, R,VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY. <br /> _ <br /> ADDRESS: Wn Clty/State/Zlp 1 P 0 <br /> PHONE(1): PHONE(2) � FACSIMILE: 33 <br /> TENTATIVE"APDM <br /> POINTMENT DAT Time. <br /> (Please allow 10 buslnes5 day Pro data of appl tion submittal-"Tentadva only-must b conflrmed) <br /> CHECK BOX TO EXPEDITER CIU - OS FEE GAS R ONLY)-REQUEST PROCESSED IN S BUSIN S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1 148 <br /> Electronic Infortnation: List Map^Descrlpt on: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CI 0it t <br /> 1. Q 5 <br /> {� <br /> 2. U��, II-Vi V&S�Noco(.' Unit2 1 <br /> a. ' A) !W <br /> 4. Noun,f 3dj,lti�C (� <br /> 5, <br /> Unit 4 <br /> Mx <br /> T- l o Unit 5 <br /> 8- Q W,. ' 5 s CDl`� <br /> ,0 tA5IG 9. W. U07,N01 BES, NOLO Unit <br /> 10. 0 ra 1r Q o s <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROLMID TANK(UST)CLEANUP SITE(LOP) D HOUSIN®ABATEMENT LID WASTE FACILITY/VEHICLE <br /> HER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY TE TIRE l <br /> tNAIARDOUS <br /> DERGROUNDTANK(MONITORINGIREMOVAL)� C3 DOG KENNEL AIRY <br /> WASTE GENERATORDC d CHICKEN RANCH STEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY 1:1MOTELIHOTEL MPER TRUCKIYARDICHEM ToLET9 <br /> v 17 TATTOOIBOOT PIERCING D POOLISPA NO USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> _ WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:00PM -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(2091464-0138 or mail to the a dress 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 recelpt of application. The flies 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 filo 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$106 deposit prior to review. <br /> EHD USE ONLY <br /> Q• (' 4 <br /> EHD 48-06 8/04106 PU$LIC RECORDS RELEASE APP FORM <br /> I <br />