Laserfiche WebLink
0 <br /> r1 r r—1 Pip <br /> Ei ILe LOGNUMBERNUMBERNUMBER�R r <br /> '�1[ SAN OAQUI C€UHT' <br /> �� <br /> F.pENVIRONMENTAL HEALTHDEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ; �JW6%phone: (209) 468-3420 Fax: (209) 464-0135 Web: a.sigov.or /� <br /> SE RViC - PULIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> &V t BUSINE SIAGE CY: <br /> ADDRESS: w c CtTYISTAT /ZIP: <br /> PHONE(1): I 1 PHONE( )• � FACSIMILE- - - � . <br /> TENrATIVE'APPOINTMENT DATE: Time: <br /> ('Please allow 10 business days from date of appiicakian subr#liftal-`F ?aSve t�nly-rriersf&��rrflrrned) <br /> CHECK BOX TO EXPEDITE REQUEST- 2 FEE(CASH C7R CHECK n, na TT,RtIGESSED IN 3 BUSIIJES lJ <br /> SIGNATURE OF APPLICANT <br /> E[ectronlc information: ❑List ap—Description; <br /> FILE ADDRESS l=1°tl USE QNLY <br /> Street# Street Name C <br /> Ct Unit 4 <br /> 3. <br /> —� <br /> 3 <br /> 5. <br /> 6. I <br /> .............. ......_.......... ....... .......__ ..._. <br /> _. it <br /> r, E <br /> 8. <br /> C3 Unit <br /> 9. i <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH 00-ATMENT FILES � '" <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT SOLID WASTE FACILITWEHICLE T <br /> OTHER CLEANUP SITE(Nou-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK{t° ONITORINGIRE1 OVAL) ❑DOG KENNEL ❑DAIRY l <br /> HAZARDOUS WASTE GENERATOR v�- ❑CHICKEN RANCH iiASTEwATER TREATMENT PLAmT �}>� <br /> TIERED PERMITTED FACILITY,21, ❑MOTELIHOTEL FPumpERTRUCYJYARDICHEMtCALTOILETS /C!' <br /> TATToo/BoDYAERcm ❑POOLISPA <br /> El MEDICAL WASTE FAcuty ❑LAND USE APPLICATION SITES <br /> ®OTH€R€PL€k�SPECIFY) <br /> WELL AND S€PTIG PERNT RECORDS ARE AVAiLAsLE FOR REVIEW: CN DAY-FRIDAY 8:00 Aw6:00PM(EXCLUDING HotjDAYS) <br /> 1. List u ,to ten addresseI in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At toast one file type MUST be selected. Fax to209E 138 or mail to the addressInd' ted above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. 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 confr 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$122 deposit prior to review. <br /> USE ONLY <br /> END <br />