Laserfiche WebLink
EHD LOG NUMBER <br /> DATE RECEIifEI� <br /> ter; sGi�l � SAN JOAQUIN COUNT- <br /> �` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> MAR 2 6 200.9 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjg0V.0 <br /> ENViRMNIENT HEALTH <br /> PERlkfil-T/SFRViGES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS GENCY: uS <br /> �+ r <br /> ADDRESS: '�� CITYISTATEIZIP_ �`�� 9-f <br /> nf FACSIMILE: <br /> PHO_NE(1);2 2J_r IJ —y'I PHONE(2a: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE RE ST $105.00 CASK R CHECK ONLY)_REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 03- <br /> Electronic <br /> 3-_Electronic Information: ❑ List❑ Map—Description: <br /> I FILE ADDRESS EHD USE ONLY <br /> i <br /> Street# Street Name City Unit 1 <br /> 1. <br /> L4 Lf W }-( �.��� u1 ST�7CC7�1� :r <br /> ❑ Unit 2 <br /> 3. <br /> j Unit 3 *, <br /> 4. <br /> 5. <br /> Unit 4 <br /> 6. _ <br /> 7. ❑ Unit 5 <br /> - <br /> I 9. ❑ Unit 6 <br /> 10. 4{ <br /> Specific Date Range of Information Requested: From to <br /> - <br /> ENVIRONMENTAL HEALTH DEPARTMENT,FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOUD WASTE FACILITYIVEHICLE <br /> ,RL OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE <br /> Z UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR <br /> M CHICKEN RANCH 17 WASTEWATER TREATMENT PLANT <br /> W TIERED PERMITTED FACILITY d MOTELIHOTEL Q PUMPER TRUCKIYARDICHEMTOILETS <br /> ❑TATTOOIBODY PIERCING M POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) oL <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - 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(209).4640138 or mail to the address indicated above. Address <br /> I 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 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. ie <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$105.00 deposit-prior to review. <br /> EHD USE ONLY <br /> I ***If you need further assistance please contact Diane Martinezr (209)468-3425 directly. Thank You*** <br />