Laserfiche WebLink
K�l,s <br /> AlFt1 AQUIN Envirroa mental Health Department <br /> OU NTY PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIROIVMEkAH4LrAffHyrcws her^ <br /> PERMIT/SERVICES EHD LOG NUMBER: V • <br /> WPPLICANT: i, Aj C ( BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: 4/Ki,� , Cit °I SzZo <br /> PHONE (1): PHONE (2): FAX OR E-MAIL: 4QmCG <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 da and time to review the requested a ords <br /> SIGNATURE OF APPLICANT =—� �y DATE / <br /> 1. List up to ten addresses in the space below. Address ranges -T-be accepted. Select the type(s) 6f 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 infoasicehd.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. 14/1Future file reviews by the same applicant may require a$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( P gaccepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be <br /> Underground Tank(UST/)) Street# Street Name City <br /> Cleanup Site(LOP) v top fl <br /> i oesuM,ER <br /> V�Other Cleanup Site(Non-LOP) T r LG7 <br /> Hazardous Waste 5�f `µM,IA wf AyT` <br /> Tiered Permitted Facility 2 <br /> Aboveground Tank <br /> UST (Monitoring/Removal) ❑PWS <br /> Hazardous Materials 3 <br /> 'Spill I Release Response �2 <br /> ZSalid Waste Facility I Vehicle 4 AA`zRQUA_rrY <br /> Food Facility I C <br /> S'Pool/Spa PSPE MmeATION <br /> t�{Dairy 5 <br /> Land Use Application Sites <br /> Septic Pumper Truck I ousiNc <br /> 6 <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Planta YCUPA <br /> V Housing Abatement y AST/HM/HW <br /> Motel/Hotel <br /> b/Chicken Ranch/Dog Kennel CUPA <br /> e <br /> Medical Waste Facility UST <br /> 14 Taftoc/Body Piercing SODo WAM <br /> LOther <br /> a <br /> ;e Specify): ❑ACCOUN➢Na <br /> L. � ,6 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> TORecords provided by Staff-PPR Complete. Staff Name: EHD 4e-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www-sjcelid.com <br />